What is hormone replacement therapy (HRT) used for?
HRT is a form of hormone-based treatment designed to relieve the symptoms of menopause. HRT aims to replace some of the hormones that the body stops producing during menopause, to combat some of the associated biological changes including reduction in bone density, recurring hot flashes, and night sweats (1). The hormones used in HRT are forms of estrogen, progesterone, and sometimes testosterone.
What are the different types of HRT?
There are several types of HRT currently available which include:
- Combined HRT: This is the most commonly prescribed type of HRT and contains a combination of both estrogen and progestogen. The estrogen is largely responsible for the improvement of menopausal symptoms, while the progestogen (a form of progesterone) protects the womb from being overstimulated by estrogen, which could otherwise increase the risk of endometrial cancer (2).If you are postmenopausal (periods have ceased for at least one year), estrogen and progestogen will be delivered continuously at a low dose. If you are perimenopausal and still having periods, sequential HRT may be used to regulate hormone levels. In this type of HRT, estrogen is released continuously, but progesterone is only released for part of the month.
- Estrogen-only HRT: This type of HRT is typically prescribed for symptom relief in women who have had their womb removed via a hysterectomy, as they are not at risk of developing endometrial cancer without progestogen (1)
- Tibolone: Available in select countries, this formulation has weak estrogen, progesterone, and testosterone-like action. Tibolone is very safe and is effective in many women but less effective in others (1)
HRT can also be delivered is various forms, for example
- Oral tablets: These are considered the most convenient and are well-absorbed
- Transdermal gels or patches, where the hormones are absorbed through the skin
- Creams or tablets administered through the vagina: this has a more localized effect, so it is more effective for vaginal symptoms (e.g., vaginal dryness) (1)
- Devices such as the UID, used to deliver progestogen directly to the uterus
How long should I use HRT for?
There is no line in the sand! How long you use Hormone Replacement Therapy will depend on several factors such as the severity of your symptoms, or your individual treatment goals that you have discussed with your doctor.
What’s most important when taking HRT is that you visit your GP regularly to determine its effectiveness, monitor any symptoms or side effects you’re experiencing, and to monitor your health markers e.g. bone density. All of these factors will determine how long you require the treatment, and when it can be stopped (3).
What are the pros and cons of taking HRT?
There are a number of pros and cons of HRT to consider when thinking about commencing this type of treatment.
Firstly, HRT has proven to be an effective form of treatment for menopausal symptoms for many women, with benefits including:
- Reduction in osteoporosis and bone fracture (4)
- Reduction in hot flushes and night sweats (4). This will often lead to improved sleep, mental clarity and quality of life!
- Improved vaginal dryness with vaginal cream and tablets (1)
- Reduced mortality and protect against heart disease, if commenced within 10 years post menopause (4, 5)
However, it is also important to be aware of the ‘cons’, and potential side effects and risks associated with HRT, which include:
Mood changes, bloating, headaches and/or tender breasts. These symptoms are often related to the type of progestogen used and may be reduced by using a different form of treatment, for example micronized progesterone and dydrogesterone (4).
Blood clotting: Oral HRT has been linked to increased risk of blood clotting and venous thromboembolic (VTE) disease, especially for people who are predisposed to these health conditions. This includes people who are overweight or smoke. However, research shows there is no such risk associated with transdermal HRT at doses less than 50mcg/24 hours (4,5).
Breast Cancer Risk: According to research, there may be a small increase in risk of breast cancer from HRT use, however;
- This risk is reduced with shorter treatment duration and in oestrogen only formulations
- Risk declines after ceasing treatment
- There is no evidence of risk with the use of vaginal oestrogen
- For women who are at an increased risk of developing breast cancer due to a family history or being obese, risk does not seem to increase further with HRT use (4,6)
What about stroke? Commencing HRT more than 10 years after the onset of menopause, may place women at a higher risk of stroke (7). However, women who undergo HRT in their 50’s (or within the first 10 years of menopause) and who do not have pre existing risk factors, are not at increased risk of stroke (4)
If you’re concerned about the potential risks, or side effects of using HRT, it’s always best to speak with your GP to decide the best course of action for you.
Who is a candidate for HRT during menopause?
It is important to discuss your suitability for HRT with your doctor, as it will depend on many factors including age, medical history, presence of risk factors and symptom severity and type.
- According to the Australian Menopause Society, the benefits of Hormone Replacement Therapy seem to outweigh the risks for many women who:
- Are in their 50’s, or within 10 years of the onset of menopause and
- Have not had breast cancer or other hormone dependent cancer and
- Are suffering with symptoms which are affecting their quality of life or health status, including night sweats and low bone density (4).
For women who experience early menopause (before 40 years old), Hormone Replacement Therapy is almost always advised to be taken at least until the average age of menopause (51 years old). This is because these women are more at risk of developing long term health consequences related to low oestrogen (3).
Remember.. lifestyle matters too!
While Hormone Replacement Therapy may be a good treatment option to provide relief from the symptoms of menopause, it is important to remember that lifestyle changes can have a positive impact too. Making changes to your nutrition, levels of physical activity, sleep, and stress management can help improve symptoms and quality of life!
We understand that this is not always easy, so our Accredited Practising Dietitians at Miyagi are here to help! Book your free assessment today to learn more about our Master Menopause Program and to speak to one of our friendly staff about how we can help you today.
Written By Gabby Zammit
Accredited Practising Dietitian