The Ultimate Guide to Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is a widely used and scientifically backed treatment designed to help women manage the symptoms of menopause and perimenopause. This guide is informed by the expertise of Dr. Anna Cantlay, a highly experienced GP specializing in menopause and women’s health. Dr. Cantlay’s insights provide clarity on how HRT works, its benefits, potential risks, and different methods of administration. For those seeking further information, Dr. Cantlay offers valuable resources through her practice, Eve Health Hormones.

What is HRT? 

HRT stands for Hormone Replacement Therapy, a prescription treatment that helps balance hormone levels in women experiencing menopause or perimenopause. It can also be used to treat other conditions, such as premature ovarian insufficiency (POI) and severe premenstrual dysphoric disorder (PMDD). The therapy primarily involves estrogen and a progestogen, with the type and dosage determined based on individual health needs.

Types of HRT 

HRT comes in different formulations and delivery methods, allowing women to choose what best suits their lifestyle and medical history. The main types include:

• Estrogen-only HRT: Usually prescribed for women who have had a hysterectomy.
• Combined HRT (Estrogen and Progestogen): Recommended for women who still have a uterus to protect against endometrial cancer.
• Body-identical HRT: Uses hormones that are molecularly identical to those produced by the human body, making them a preferred choice for many doctors and patients as they have lower risks and generally lower side effects. 

Forms of HRT Administration 

There are several ways to take HRT, each with its own benefits:

• Patches: Applied to the skin and replaced every few days, providing continuous hormone delivery.
• Gels: Absorbed through the skin and applied daily.
• Sprays: A quick and easy method, also absorbed through the skin.
• Tablets or capsules Taken orally.
• Vaginal Estrogen: Applied as creams, pessaries, or rings, primarily to address genitourinary syndrome of menopause.
• Implants: Small pellets inserted under the skin, providing long-term hormonal support.

When Should You Consider HRT? 

If you are experiencing symptoms of menopause or perimenopause, such as:

• Hot flushes and night sweats
• Mood swings, anxiety, or depression
• Vaginal dryness and discomfort during intercourse
• Sleep disturbances
• Decreased libido
• Brain fog and memory issues
• Joint pain or muscle aches
• Increased risk of osteoporosis

Then HRT may be a beneficial option. 

Blood tests are not always helpful in perimenopause diagnosis as they are often normal. Blood tests are needed in women experiencing symptoms <40 years to identify POI. 

Getting the Right Diagnosis 

Many women struggle to get proper treatment, often being misdiagnosed or prescribed antidepressants instead of HRT. If you feel your symptoms are being overlooked, it is advisable to seek a second opinion or consult a menopause specialist. Resources such as the NICE guidelines highlight that HRT should be considered as the first-line treatment for menopause symptoms and for psychological symptoms in menopause. 

Dr. Cantlay emphasizes the importance of self-advocacy and education when seeking menopause care. 

How to Choose the Right Dose 

HRT is not a one-size-fits-all solution. Most women start with a low dose, which can be gradually increased if necessary. Dosing needs to be personalised to the woman. Some women absorb gels better than patches and vice versa.

Doctors often recommend a trial period of three months before making any dose adjustments.

Side Effects and What to Expect 

As with any medication, HRT comes with potential side effects, though many women tolerate it well. Common side effects include:

• Breast tenderness
• Bloating
• Nausea
• Headaches
• Mood changes
• Weight fluctuations

These usually subside as the body adjusts to the hormones. If symptoms persist, switching to a different form or adjusting the dosage can help. Regular follow-ups with a doctor can ensure that any issues are addressed promptly.

Addressing Common Concerns 

Many women worry about the risks associated with HRT, particularly regarding breast cancer. Risks vary dependent on the type and duration fo HRT used.  However, modern research shows that HRT is generally safe for most women, particularly when started within the first 10 years of menopause. Risks to consider:

• Breast Cancer: Risk depends on the type of HRT used and duration of HRT. Oestrogen only HRT little  to no risk. Combined HRT slight increased risk, that varies dependent on the progestogen used. 
• Endometrial cancer: Increased risk with unopposed oestrogen, or sequential HRT use >5 years. 
• Cardiovascular Health: Transdermal estrogen (patches, gels, sprays) does not increase the risk of blood clots, making it a safer choice for those concerned about cardiovascular disease.
• Bone Health: HRT helps protect against osteoporosis and reduces fracture risk.
• Cognitive Function: Emerging research suggests a potential role for HRT in supporting brain health but more research is needed. 

HRT Availability and Shortages 

With the growing awareness of menopause treatments, demand for HRT has surged, leading to supply shortages. If your prescribed brand is unavailable, pharmacists can often offer an equivalent alternative. It’s best to discuss options with your doctor to ensure a smooth transition to a different brand.

Can You Stay on HRT Forever? 

There is no mandatory cut-off age for HRT. Some women continue therapy into their 60s and 70s, provided the benefits outweigh any risks. The decision to stay on HRT should be reviewed periodically with a healthcare provider, considering factors like:

• Cardiovascular health
• Bone density
• Overall quality of life

Recent studies suggest that transdermal HRT remains safe even in older women, challenging previous limitations on long-term use. Lifestyle factors such as diet, exercise, and stress management should also be considered in conjunction with HRT for optimal well-being.

Final Thoughts

The Benefits of HRT
HRT is more than just symptom relief—it offers numerous long-term health benefits, including:

• Cardiovascular Protection: Estrogen has a positive effect on blood vessels, reducing the risk of heart disease.
• Bone Health: Prevents osteoporosis by maintaining bone density.
• Brain Health: May lower the risk of dementia and cognitive decline.
• Quality of Life: Improves mood, sleep, and overall well-being.
• Skin and Hair Health: Estrogen has been linked to improved skin elasticity and hair growth.
• Metabolic Support: Some women experience better weight management and reduced insulin resistance with HRT.

If you are experiencing menopausal symptoms and wondering if HRT is right for you, consult your doctor or a menopause specialist. Dr. Anna Cantlay provides in-depth consultations and resources through Eve Health Hormones for those who wish to explore their options further.

HRT is a transformative option that has helped millions of women regain control over their health and well-being. Don’t be afraid to explore your options and make an informed decision that aligns with your health goals.