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Harley Street

Hormones and Hormone Replacement Therapy (HRT) at Menopause

Quick facts about your hormones and HRT:

  • Whether you take HRT or not should always be YOUR choice.
  • There are pros and cons to taking HRT.
  • There are pros and cons to not taking HRT.
  • If you are going to take HRT, make sure you are taking Body Identical HRT.
  • We do not recommend taking Bio Identical HRT.
  • Your HRT needs to be personalised to your needs - there are lots of different type of HRT so if one form doesn’t suit you there will be others you can try.

Let's look in more detail at HRT and whether it is right for you...

Lots of people are keen to tell you what you should and shouldn’t be doing for your menopause. We really try not to do that here. Harley Street at Home is all about giving you evidence-based information so that you can make the choices which are right for you.

One of the BIG choices to think about is whether you want to use Hormone Replacement Therapy (HRT) to manage your symptoms. Some women choose not to take HRT because they don’t want even the slightest increased risk of breast cancer. Other women have existing health issues which make taking HRT a more difficult choice.

While we will never tell you what to do, we are absolutely committed to making sure you have the most up to date, evidence-based, information about treatments – when it comes to HRT it’s all about weighing up pros and cons and those will vary from one woman to another.

If you choose to start taking some HRT in your peri-menopause, when you are still having periods, there are some very definite health benefits.

Pros:

  • Menopause symptom relief.
  • Protection against osteoporosis, Alzheimer’s Disease, heart disease, stroke, and metabolic diseases.

Cons:

  • Very slight increased risk of breast cancer when you take combined Oestrogen/Progesterone HRT.
  • The increase in risk is like the increased risk for women who drink 2 glasses of wine an evening, or the same as women who take the combined contraceptive pill.
  • There is no increased risk of dying from breast cancer when you take HRT.
  • The risk of developing breast cancer is six times higher in women who are obese than it is from women who take HRT.

Body identical or Bio Identical HRT?

The only type of HRT we, and the British Menopause Society, recommend you consider is Body Identical Hormone Replacement Therapy.

Body Identical HRT is regulated, it’s the safest to use and has the lowest risk of any side effects. 'Body identical' means the hormones are the same as the hormones you have in your body.

Bio Identical Hormone Replacement Therapy is not regulated at all, and our experts are concerned about how pure some of the bio-identical hormones are and how safe they are.

The consensus is that taking oestrogen through your skin using patches, gels or sprays is preferable to taking tablets.

The type of body-identical progesterone which is considered the safest to use is called 'micronized progesterone'.

Body-Identical HRT is what you would be prescribed through the NHS by your GP. If you are receiving HRT on a private prescription, we would recommend that you check your HRT is Body Identical and not Bio Identical HRT.

The hormones involved in menopause and HRT

Oestrogen

The best and safest way to take oestrogen is through the skin using either a gel, a spray, or a patch. The hormone is the same whichever way you prefer to take it, so the choice is really about your preference.

Gels come in pump dispensers – Estrogel or in a disposable sachet - Sandrena.

You apply the gels to your skin, usually your leg, arm, buttock, or your tummy. The amount of gel you use is determined by the dose of oestrogen you are recommended to take.

Patches are small, sticky and transparent - a bit like a plaster. You apply the patch to your skin and change it every few days. There are some which contain oestrogen only and some which contain a mixture of oestrogen and progesterone.

Lenzetto is a newer way to take oestrogen, it comes in a bottle that your spray onto the skin and is quickly absorbed.

Oestrogen gels and patches are available on NHS prescriptions. Oestrogen spray is only available privately for now.

It can take between a few days and a few months for menopauses symptoms to improve. You might experience a few mild side-effects in the first few months of taking oestrogen and these should settle over time.

When you start taking oestrogen HRT you should review how you’re feeling with your prescriber after 3 months and if everything is going well from there you should go on to an annual review.

Your menopause changes over time so it’s important to make sure your HRT continues to keep any symptoms controlled.

Progesterone

Unless you’ve had a hysterectomy you’ve probably still got your uterus, in which case it will be safest for you have some progesterone as well as oestrogen HRT. The oestrogen in your HRT stimulates the lining of your uterus the thicken, like it would before a period. If it gets too thick your risk of cancer increases so taking progesterone keeps this under control. Ideally your HRT needs to mimic as closely as possible what would be happening naturally.

You can take progesterone as a tablet (Utrogestan) a cream or using the Mirena Coil which some women use as a contraceptive device, too. The Mirena coil contains some oestrogen and enough progesterone to protect you - you might need to add a little extra oestrogen using a gel, spray, or patch.

Some women love the coil because once it’s fitted you can just forget about it for 5 years, until it needs removing or replacing.

Utrogestan is a tablet, so you need to remember to take it. Most women take it orally, but some women prefer to take it vaginally. You should discuss options with your prescriber.

Utrogestan can be taken cyclically or continuously. If you are still having periods in the peri-menopause, you’ll take it cyclically on days 17-28 of your cycle. If your periods have stopped, you will take Utrogestan continuously.

Taking progesterone at night helps a lot of women sleep better.

Testosterone

You might be surprised to see testosterone as a hormone connected with menopause. We always think of testosterone as a male hormone, but women make it too in the ovaries. Just as with oestrogen and progesterone your levels of testosterone start to reduce around peri-menopause.

Not every woman experience symptoms of low testosterone but those who do tend to feel their “va- va voom” is missing, they often say they have less strength, low energy and their libido and sexual function suffers. You might find is lower than normal if your testosterone is low and sometimes muscle and joint aches are worse.

Testosterone can be added to your HRT, but it’s often not included until you have been taking oestrogen and/or progesterone for at least three months.

Please don’t worry, taking testosterone at the sort of doses used in HRT does not put hair on your chest or lower your voice - it’s merely used to replace testosterone levels you’d have normally before peri-menopause.

In the UK the only testosterone product designed for female use is available by private prescription only. It’s called Androfeme and is imported from Australia.

Hopefully you can see that if you choose to take HRT there is a wide choice of ways to take it and combinations of hormones to take. Some women are lucky and the first prescription of HRT they ever have suits them perfectly - but for most women a few tweaks and adjustments are needed to get it just right. It’s a bit like being fitted for a well-tailored suit, you need a few fittings to get it just right! - Every woman is different and each woman’s hormone requirements are different.

Getting personal advice

If you speak to a doctor about your treatment options, we really hope you will be presented with evidence-based information and allowed to make the choices. But we know that isn’t always the case. If you hit a brick wall, you don’t just have to accept the first answer you’re give.

You need expert advice

It’s useful to check if any of the doctors at your surgery are menopause specialists, trained by the British Menopause Society. You may also find there is a Nurse Practitioner in your practice who has a special interest and has received training in Menopaus.

You can also search for the nearest menopause Specialist Doctors in your area here

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