Gynecology
Dr. Marwa
Hormonal replacement therapy
Hormone replacement therapy (HRT) is a treatment to relieve symptoms of
the menopause. It replaces hormones that are at a lower level as you
approach the menopause.
Benefits of HRT
The main benefit of HRT is that it can help relieve most of the menopausal
symptoms, such as: *hot flushes *night sweats *mood swings *vaginal
dryness *reduced sex drive
Many of these symptoms pass after a few years, but they can be unpleasant
and taking HRT can offer relief for many women.
*It can also help prevent weakening of the bones (osteoporosis), which is
more common after the menopause.
Risks of HRT
Breast cancer:
Women who take HRT for more than 1 year have a higher risk
of breast cancer than women who never use HRT. The risk is linked to all
types of HRT except vaginal oestrogen.
For women in their 40s and 50s who
take HRT for 5 years there would be:
1 extra case for every 200 women taking oestrogen-only HRT
1 extra case for every 70 women taking cyclical HRT
1 extra case for every 50 women taking continuous HR
Ovarian cancer:
t's thought that if there is any increase in cases of ovarian
cancer among women taking HRT, the increase is very small.
Endometrial cancer:
Oestrogen-only HRT can increase the risk of endometrial
cancer.
Taking combined HRT, particularly a course of continuous
combined HRT (where you take both medicines without a regular break),
largely eliminates this risk.
Blood clots:
Blood clots can be serious if they become lodged in a blood
vessel and block the flow of blood.
The evidence shows that:
taking HRT
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Dr. Marwa
tablets can increase your risk of blood clots. there's no increased risk of blood
clots from HRT patches or gels
It's thought the risk of developing a blood clot is 2 to 4 times higher than
normal for women taking HRT tablets. But as the risk of menopausal women
developing blood clots is usually very low, the overall risk from taking HRT
tablets is still small. It's estimated that for every 1,000 women taking HRT
tablets for 7.5 years, fewer than 2 will develop a blood clot.
Heart disease and strokes:
The evidence shows that: HRT does not significantly
increase the risk of cardiovascular disease (including heart disease and
strokes) when started before 60 years of age. oestrogen-only HRT is
associated with no, or reduced, risk of heart disease. combined HRT is
associated with little or no increase in the risk of heart disease
taking oestrogen tablets is associated with a small increase in the risk of
stroke, but the risk of stroke for women under age 60 is generally very low, so
the overall risk is still small
Who can take HRT
Most women can have HRT if they're having symptoms associated with the
menopause. But HRT may not be suitable if you:
*have a history of breast cancer, ovarian cancer or endometrial cancer
*have a history of blood clots
*have untreated high blood pressure – your blood pressure will need to be
controlled before you can start HRT
*have liver disease
*are pregnant – it's still possible to get pregnant while taking HRT, so you
should use contraception until 2 years after your last period if you're under
50, or for 1 year after the age of 50
HRT hormones
HRT replaces the hormones that a woman's body no longer produces
because of the menopause. The 2 main hormones used in HRT are
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Dr. Marwa
*oestrogen – types used include estradiol, estrone and estriol
*progestogen – a synthetic version of the hormone progesterone, such as
dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel
HRT involves either taking both of these hormones (combined HRT) or just
taking oestrogen (oestrogen-only HRT). Most women take combined HRT
because taking oestrogen on its own can increase your risk of developing
endometrial cancer. Taking progestogen alongside oestrogen minimises
this risk. Oestrogen-only HRT is usually only recommended for women who
have had their womb removed during a hysterectomy.
Ways of taking HRT Tablets
Tablets:
are 1 of the most common forms of HRT. They are usually taken once a
day. Both oestrogen-only and combined HRT are available as tablets. For
some women this may be the simplest way of having treatment.
Skin patches:
Skin patches are also a common way of taking HRT. You
stick
them to her skin and replace them every few days. Oestrogen-only and
combined HRT patches are available. Skin patches may be a better option
than tablets if you find it inconvenient to take a tablet every day.
Oestrogen gel:
Oestrogen gel is an increasingly popular form of HRT. It's
rubbed onto your skin once a day.
Like skin patches, gel can be a
convenient way of taking HRT and does not increase your risk of blood clots.
Implants:
HRT also comes as small pellet-like implants that are inserted under
her skin (usually in the tummy area) after her skin has been numbed with
local anaesthetic.
The implant releases oestrogen gradually and lasts for
several months before needing to be replaced.
This may be a convenient
option if you do not want to worry about taking your treatment every day or
every few days. But if you still have your womb, you'll need to take
progestogen separately too.
Vaginal oestrogen:
Oestrogen is also available as a cream, pessary or ring
that is placed inside her vagina.
This can help relieve vaginal dryness, but will
not help with other symptoms such as hot flushes.
It does not carry the usual
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Dr. Marwa
risks of HRT and does not increase your risk of breast cancer, so you can use
it without taking progestogen, even if you still have a womb.
Testosterone:
Testosterone is available as a gel that you rub onto her skin. It is
usually only recommended for women whose low sex drive (libido) does not
improve after using HRT. It is used alongside another type of HRT.
Current
testosterone products available in the UK (such as Tostran and Testogel) are
currently unlicensed for the treatment of low sex drive. This means the
manufacturers of these products have not specified that they can be used
in this way. Despite this, there is evidence that testosterone can be
effective.
HRT treatment routines
treatment routine for HRT depends on whether she is in the early stages of
the menopause or she had menopausal symptoms for some time.
The 2
types of routines are cyclical (or sequential) HRT and continuous combined
HRT.
Cyclical HRT:
Cyclical HRT, also known as sequential HRT, is often recommended for
women taking combined HRT who have menopausal symptoms but still have
their periods. There are 2 types of cyclical HRT:
monthly HRT – you take oestrogen every day, and take progestogen
alongside it for the last 14 days of your menstrual cycle
3-monthly HRT – you take oestrogen every day, and take progestogen
alongside it for around 14 days every 3 months
Monthly HRT is usually recommended for women having regular periods.
3-monthly HRT is usually recommended for women having irregular periods.
You should have a period every 3 months.
It's useful to maintain regular periods so you know when your periods
naturally stop and when you're likely to
Continuous combined HRT:
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Dr. Marwa
Continuous combined HRT is usually recommended for women who are
postmenopausal. A woman is usually said to be postmenopausal if she has
not had a period for 1 year.
Continuous combined HRT involves taking
oestrogen and progestogen every day without a break.
Oestrogen-only HRT
is also usually taken every day without a break.
Side effects of HRT
As with any medicine, HRT can cause side effects. But these will usually pass
within 3 months of starting treatment. Common side effects include: breast
tenderness , headaches, feeling sick, indigestion, abdominal (tummy)
pain, vaginal bleeding
Alternatives to HRT
Alternatives to HRT include:
*lifestyle measures. such as exercising regularly, eating a healthy diet,
cutting down on coffee, alcohol and spicy
foods, and stopping smoking
*tibolone – a medicine that's similar to combined HRT (oestrogen and
progestogen), but may not be as effective and is only suitable for women
who had their last period more than 1 year ago
*antidepressants – some antidepressants can help with hot flushes and night
sweats, although they can also cause unpleasant side effects such as
agitation and dizziness
*clonidine – a non-hormonal medicine that may help reduce hot flushes and
night sweats in some women.