Hormone replacement therapy (HRT) is used to reduce the symptoms of menopause, which is a natural part of ageing for women. Menopause happens when your ovaries stop releasing eggs as a result of falling levels of oestrogen. This reduction in oestrogen causes the symptoms usually associated with menopause.
Symptoms of menopause
Symptoms of menopause include:
- hot flushes
- night sweats
- headaches
- vaginal dryness
- urinary infections
- mood swings.
What are the main types of HRT?
There are two types of HRT:
- Combined HRT. This contains oestrogen and progesterone and is used for women who haven’t had a hysterectomy. Taking oestrogen on its own can lead to uncontrolled growth of the lining of the womb and increase your risk of developing womb (endometrial) cancer. If you’ve had a partial hysterectomy you may still have some of your womb lining present, so it’s most likely that you’ll need to take both hormones.
- Oestrogen-only HRT. This option is suitable for women who’ve had a total hysterectomy.
Your GP or gynaecologist will discuss your options with you.
What are the benefits of HRT?
The main benefits of taking HRT are relief from menopause symptoms such as:
- hot flushes
- night sweats, which may mean improved sleep
- vaginal dryness
- urinary infections.
HRT can also maintain vaginal muscle tone, which may help to reduce urinary incontinence. Low oestrogen levels can also weaken your bones, which may cause them to break more easily (a condition called osteoporosis). In the long-term, HRT can help reduce the risk of this.
Is HRT safe?
All medicines have some risks, however, HRT is generally safe for most women going through menopause.
Common side effects of HRT
Common side effects of HRT can include:
- breast tenderness
- leg cramps
- headaches
- feeling sick
- bloating and fluid retention with swelling of your ankles or face.
There isn’t enough evidence to suggest that HRT causes weight gain. Many women gain weight when they reach menopause. But this may be your body's way of producing more oestrogen, as your body fat can produce some oestrogen after menopause.
Most side effects of HRT get better within a couple of months. If they don't improve, your GP may suggest you try a different oestrogen or progesterone, depending on what’s causing your side effects.
Less common problems with HRT
In some women HRT can increase the risks of developing:
- stroke
- breast cancer
- endometrial cancer (with oestrogen-only HRT)
- deep vein thrombosis, which is a blood clot in your leg vein.
The risks of developing these types of problems are small, but your GP or gynaecologist will talk to you about them before starting any treatment. Because of these risks you generally won’t be prescribed HRT if you’ve had one of these problems in the past. It isn’t clear yet whether HRT contributes to developing heart disease, ovarian cancer, or dementia.
If you're taking HRT, it's important to have regular mammograms and be breast aware. This means knowing how your breasts look and feel, and knowing what changes to look out for. If you're worried about any changes to your breasts, see your GP.
Should I take HRT?
The decision to take or stay on HRT is one that should be decided with your GP or gynaecologist. You need to weigh up the risks and benefits and consider factors such as:
- your age - the risks and benefits of HRT are different for women just starting their menopause compared to older women
- your symptoms and how severe they are
- your personal and family medical history
- results of relevant tests
- your preferences and expectations.
How long you should take HRT is also an individual decision for you to make with your doctor’s advice and support.
Further information
NPS
www.nps.org.au
Australian Menopause Society
http://www.menopause.org.au/
Sources
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National Health and Medical Research Council. Hormone Replacement Therapy: A summary of the evidence, for General Practitioners and other Health Professionals. [online] Canberra, ACT: Commonwealth of Australia. Mar 2005 [Accessed 12 Jul 2011] Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/wh35.pdf
National Health and Medical Research Council. Hormone Replacement Therapy: Exploring the Options for Women. [online] Canberra, ACT: Commonwealth of Australia. Mar 2005 [Accessed 12 Jul 2011] Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/wh36.pdf
National Health and Medical Research Council. Making decisions: Should I use hormone replacement therapy? [online] Canberra, ACT: Commonwealth of Australia. Mar 2005 [Accessed 12 Jul 2011] Available from: http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/wh37.pdf
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Hormone therapy advice. [online] East Melbourne, VIC: RANZCOG. 2004 [Last updated Jul 2009, accessed 14 Jul 2011] Available from: http://www.ranzcog.edu.au/publications/statements/C-gyn16.pdf
Santen RJ Allred DC Ardoin SP et al. Postmenopausal Hormone Therapy: An Endocrine Society Scientific Statement. J. Clin. Endocrinol. Metab. 2010; 95(7 Suppl 1): s1-s66.
Sturdee DW Pines A International Menopause Society Writing Group et al. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric. 2011; 14: 302–332.
Last published: 30 July 2011
