Most women will experience some symptoms as they go through the menopause. Common symptoms include hot flushes, night sweats, mood changes and vaginal dryness. These symptoms are due to changes in hormone levels during the menopause.

Hormone replacement therapy (HRT) adds back to the body the hormones it is missing. In the case of menopausal women, HRT primarily replenishes levels of oestrogen. In women who have not had a hysterectomy/oophorectomy (removal of the womb/ovaries), progestogen needs to be added to the oestrogen. Women who have had a hysterectomy do not need progestogen.

Protection against heart disease, osteoporosis, Alzheimer’s and cerebrovascular disease

HRT can bring relief to women who suffer from the typical menopausal symptoms such as hot flushes. If taken long term, some forms of HRT provide post-menopausal women with protection against osteoporosis (brittle bones) and heart disease.

Different methods of HRT
There are now a number of different methods of HRT. The wider option of treatments now available is more likely to enable women to find a suitable form of HRT.

Vaginal oestrogen
Vaginal creams, tablets, rings or pessaries are available that contain a very small amount of oestrogen.

They only work where they are applied and are useful for treating vaginal dryness and urinary problems. They do not affect other symptoms such as hot flushes, nor do they protect against heart disease or osteoporosis.

Advantages

• Since they contain a very small amount of oestrogen, they are unlikely to cause side effects associated with oestrogen, such as breast tenderness.
• Once the vaginal ring is inserted, the woman does not have to remember to take any more medication until a new ring is required.

Disadvantages

• Creams and pessaries can be quite difficult or messy to apply.
• They will not relieve hot flushes/night sweats or have any long term benefits.

HRT Patches
HRT patches contain oestrogen or oestrogen plus progestogen. They are replaced twice a week or weekly.

Advantages

• They are effective in relieving physical /emotional symptoms.
• They are convenient (once or twice weekly).

Disadvantages

• Some patches may cause skin irritation.
• The patch may fall off.
• Some women are embarrassed that the patch may be visible, for example when swimming or on holiday.

Implants
Implants containing oestrogen are available. They are inserted beneath the skin in the abdominal area, under local anaesthetic. They release the oestrogen over many months.

Advantages

• They are effective in relieving physical/emotional symptoms.
• Once inserted, there is no need to remember to take the medication.

Disadvantages

• They require a surgical procedure to insert.
• They must be inserted and removed by a doctor or nurse.
• They can be difficult to remove.
• They can have a reduced effect when used over a lengthy period, (“tachyphylaxis”).

HRT tablets
A wide range of HRT once daily tablets is now available. The majority of these treatments contain oestrogen and progestogen. This allows women who prefer tablets to find the right combination of hormones to suit their needs.

Advantages

• They are convenient.
• They are effective in relieving physical/emotional symptoms.

Disadvantages

• They may cause stomach upset.
• In women who have not had a hysterectomy some but not all types of HRT will cause vaginal bleeds (like periods). However, other tablets are available that do not involve having a period. This should be discussed with your doctor.
• Some women may not wish to take tablets for a long time.

HRT gel
Oestrogen is available in the form of a gel. It is applied once daily to a clean, dry and intact area of skin. It is rubbed onto the skin, onto each upper arm and shoulder or alternatively onto each inner thigh. The gel is clear, non-greasy and dries within minutes of application.

Advantages

• It is effective in relieving physical/emotional symptoms.
• Once applied it is invisible.
• There is a low incidence of skin reactions.

Disadvantages

• It takes a couple of minutes to apply.

If you feel that any of the treatments outlined here are suitable for you, whether or not you have taken HRT before, you should consult your doctor or practice nurse.

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