Hormone replacement therapy (HRT) at Leeds Hospital

What is HRT?

Hormone replacement therapy, or HRT, gives back the two hormones your body starts making less of in perimenopause: oestrogen and progesterone. It's used to ease the symptoms this drop in hormones can bring on.

What does HRT treat?

HRT can help with a range of menopause symptoms, including:

• hot flushes
• night sweats
• sleep problems
• mood swings
• anxiety and low mood
• vaginal dryness.

Menopause happens when your hormone levels drop and your periods stop for good. It typically arrives somewhere between your mid-forties and mid-fifties, though it can happen sooner, and can also be triggered by having your ovaries or womb surgically removed, certain cancer treatments, or genetic factors.

Most people experiencing menopause symptoms are candidates for HRT, though it's often ruled out if you've previously had breast, ovarian or womb cancer, experienced blood clots before, have blood pressure that isn't yet under control, have liver disease, or are pregnant, since pregnancy can still technically happen even while you're on it.

What are the benefits of HRT?

HRT does a good job of easing most menopause symptoms, hot flushes, low mood and vaginal dryness among them, with people generally noticing a shift within days to a few weeks of starting. It also guards against thinning bones (osteoporosis), a more common issue once menopause hits, and can help keep muscle strength from slipping.

Are there different types of HRT?

HRT can be made up of different hormones:

• Oestrogen by itself: Typically the choice once your womb has been removed surgically, or if a device within the womb is already present that releases progesterone
• Oestrogen paired with a progestogen: Needed if your womb is still in place, since the second hormone keeps its lining from thickening and reduce the risk of endometrial cancer
• Occasionally testosterone: This is prescribed only by a specialist, perhaps for a low libido.

It also comes in a range of forms:

• A daily tablet
• A patch on the skin, swapped out every few days
• A gel or spray applied to the skin once daily
• A small device fitted inside the womb, releasing progestogen only for years at a time while also preventing pregnancy
• Vaginal cream, gel, tablets or a ring, aimed at vaginal tissue thinning and dryness.

Where both hormones are needed, they can be taken cyclically – oestrogen throughout the month with the second hormone added in for roughly the final fortnight – which suits people still having periods.

Alternatively both hormones can be taken continuously every day with no break, which tends to be the choice once a full year has passed since your last period.

What happens before starting HRT?

Starting HRT doesn't typically hinge on any test results, symptoms alone are generally sufficient. A blood test might come into the picture for those between 40 and 45, or to help work out whether someone under 40 is going through an early menopause.

Jotting down anything odd your periods have been doing recently, plus a list of whatever else you take, medicine or herbal, is worth doing before you see your GP. Questions worth asking might cover how the treatment will actually help, how quickly relief tends to arrive, and roughly how long to consider taking it.

How is HRT started and monitored?

Treatment typically opens on a smaller dose, stepped up later if that turns out to be insufficient. A check-in is usually booked for around the three-month mark after you begin, or after switching to something different, to see how it's working out, settling into a yearly rhythm from there onwards.

Where things aren't improving, or side effects crop up, your GP has a few options: adjusting your dose, trying a different HRT formulation, or passing you along to a specialist in menopause care.

How long do you take HRT for?

Most people take it for 2 to 5 years, though plenty carry on for longer depending on their situation. Nobody has a hard deadline – as long as symptoms are present, the advantages tend to outweigh the disadvantages, which something worked out individually with your doctor rather than fixed from the outset.

What are the risks of HRT?

Serious complications from HRT don't come up often, though the possibilities include:

• Breast cancer risk increases slightly with combined HRT, roughly 5 additional diagnoses for every 1,000 people using it across a 5-year stretch – oestrogen taken alone barely moves this figure, if at all
• A modest rise in blood clot risk, though this applies to tablet forms specifically, sparing patches, gel and spray
• Stroke risk increases a little with tablets too, most relevant if you're past 60, an effect that again doesn't extend to patches, gel or spray.

Anyone already prone to blood clots tends to get steered towards patches, gel or spray over tablets for this reason. Keeping up with regular breast self-examination and breast screening appointments matters more than usual while you're on HRT.