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Hormone Replacement Therapy (HRT) is a well-known and effective treatment for women with symptoms of menopause.
Menopause causes your hormone levels to drop – symptoms occur due to the gradual decline in your female sex hormones; oestrogen and progesterone. The decline in oestrogen is mainly responsible for the symptoms associated with menopause. It occurs between the ages of 45 and 55 and is a natural part of ageing.
HRT allows women to manage their symptoms better by replacing the declining hormones – menopause symptoms vary a lot between women. Some sail through the menopause without any troublesome symptoms and some experience more intense symptoms.
How long do you have to take HRT? – it varies and depends on how persistent your symptoms are. If you are taking HRT for the sole purpose of treating your symptoms, then a duration of 2 to 3 years is common. How long your symptoms last for, also varies greatly. . Some symptoms appear a few months before your periods stop and some symptoms can last for years after.
As menopause can also lead to osteoporosis (fragile bones), you may have to take it for longer. Speak to your doctor if you are unsure.
What are the stages of menopause? – menopause occurs in three stages:
- Peri-menopause – this is the 3 – 5 year period that typically starts in your late 40’s, before your menopause. You begin to experience troublesome symptoms such as hot flushes, mood changes, vaginal dryness and irregular periods.
- Menopause – you are in menopause if you have had no period for twelve straight months without experiencing other causes related to illness, medicines, pregnancy or breastfeeding. The average age when a woman enters menopause in the UK is 51.
- Post-menopause – this is the time after you have had no period for twelve straight months. It is not unusual to still experience some of the symptoms you had during the peri-menopause stage.
You can reorder your HRT treatment from us – if you’ve been using HRT for 3 months with your doctor’s supervision and there have been no complications or problems, you could get more of your treatment through our online doctor service. Our quick and easy service provides a convenient way of getting a repeat supply of your HRT.
How does our HRT service work?
- You can order your HRT by completing a simple online questionnaire
- One of our doctors will review your questionnaire and confirm your suitability
- Your medicine will then be posted out to you, or you can choose to collect it from a local post office
- If you have a question about this service, please email [email protected] and one of our staff will get back to you within 24 hours
To get started on HRT – to get your first 3 months of HRT treatment, make an appointment with your GP. They will be able to assess you and prescribe treatment if they think it’s right for you.
Can I take HRT? – most women can be prescribed HRT if they are experiencing symptoms associated with the menopause that affect their daily life.
HRT may not be suitable for you if you have:
- History of breast, ovarian or womb cancer
- History of blood clots
- Blood clotting disorder (such as protein C, protein S or antithrombin deficiency)
- A blood problem called ‘porphyria’
- Recent diagnosis of angina
- Recent heart attack
- Untreated high blood pressure – your blood pressure would need to be controlled before you can start HRT
- If you have or ever had liver disease – where liver function tests have failed to return to normal
- Undiagnosed vaginal bleeding
- Untreated endometrial hyperplasia (abnormal and excessive thickening of the womb lining)
- Pregnancy – it is still possible to get pregnant whilst on HRT
HRT is not a form of contraception. You should use contraception until two years after your last period if you’re under 50 or for one year after the age of 50.
Are there any drug interactions with HRT? – speak to your doctor before taking HRT if you are on any of the following:
- Medicines for epilepsy such as phenytoin, phenobarbital and carbamazepine
- Medicines for tuberculosis such as rifampicin and rifabutin
- Medicines for HIV infection such as such as nevirapine, efavirenz, nelfinavir and ritonavir
- Medicines used to treat chronic hepatitis
- Herbal preparations containing St Johns Wort (Hypericum Perforatum)
- Bosentan (used for high blood pressure in the lungs) – this is if you on Evorel Conti patches
- Anticoagulants – this is of you are on Tibolone as it can enhance the effects of anticoagulants, particularly warfarin
There are two different types of HRT:
Oestrogen only (no progesterone) – for women who have had a hysterectomy (surgical removal of the womb) and do not need progesterone to protect the lining of their womb
Combined HRT (oestrogen and progesterone) – this is necessary for women with a womb and is given in two different ways:
- Continuous combined HRT – oestrogen and progesterone are taken together as one tablet daily continuously. There are no withdrawal bleeds
- Sequential or cyclical HRT – oestrogen only for the first 14 days then both hormones for the second 14 days. This usually results in monthly withdrawal bleeds
HRT treatment is available in many different forms, including as tablets, patches, creams, gels, pessaries, vaginal rings or implants.
We offer a range of HRT treatments which include:
- Continuous combined tablets
- Continuous combined patches
- Vaginal applications
- Steroid tablet
Continuous Combined HRT tablets – each of the following three HRT medicines are taken as one oral tablet daily (preferably at the same time each day) without any break. Each tablet contains a synthetic version of both oestrogen and progesterone. They are prescribed for treating symptoms in post-menopausal women with a womb:
Elleste Duet Conti – Elleste Duet Conti tablets contain 2 mg of estradiol hemihydrate (oestrogen) and 1 mg of norethisterone acetate (progesterone):
- It is available in pack sizes of 28 (1 month) or 84 tablets (3 months)
Kliovance – Kliovance tablets contain 1 mg of estradiol hemihydrate (oestrogen) and 0.5 mg of norethisterone acetate (progesterone):
- It is available in pack sizes of 84 tablets (3 months)
Premique Low Dose – Premique Low Dose tablets contain 0.3 mg of conjugated oestrogens and 1.5 mg of medroxyprogesterone acetate (progesterone):
- Conjugated oestrogens are a mixture of ten types of synthetic oestrogen hormones
- It is available in pack sizes of 28 (1 month) or 84 tablets (3 months)
- A higher dose of HRT called Premique was discontinued in April 2017
Elleste Duet Conti and Kliovance are also prescribed for the prevention of osteoporosis in menopausal women who are likely to have bone problems and where other treatments are not tolerated or contra-indicated (not safe to take).
Continuous Combined HRT patches:
Evorel Conti – Each patch contains 3.2 mg of estradiol hemihydrate (oestrogen) and 11.2 mg norethisterone acetate (progesterone):
- The 3.2 mg strength of estradiol is equivalent to the patch releasing 50 mcg of estradiol per 24 hours and the 11.2 mg strength of norethisterone is equivalent to the patch releasing 170 mcg per 24 hours
- It is prescribed for post-menopausal women with symptoms or for the prevention of osteoporosis in post-menopausal women who are likely to have bone problems and where other treatments are not tolerated or contra-indicated
- One patch is applied to the skin twice a week without any break
- Each patch is designed to stay on during bathing or showering
- It is available in pack sizes of 4 (2 weeks), 8 (one month) or 24 (3 months) patches
Vaginal Oestrogen (Local HRT) – local HRT works for specific symptoms such as vaginal dryness. Local HRT will not improve other symptoms such as hot flushes or protect against longer term effects of the menopause, such as osteoporosis.
Vagifem – Vagifem are tablets inserted into the vagina that contain 10 mcg of estradiol hemihydrate (oestrogen):
- It is prescribed for post-menopausal women with or without a womb who have persistent vaginal dryness and discomfort
- The initial dose is one vaginal tablet daily for two weeks. The maintenance dose is one vaginal tablet twice a week
Ovestin – Ovestin is a vaginal cream that contains estriol (oestrogen):
- It is prescribed for vaginal dryness in peri and post-menopausal women. It is also prescribed before surgery for vaginal operations
- Each gram of cream contains 1 mg of estriol.
- The cream is applied with the use of an applicator that provides a 0.5 g dose containing 0.5 mg of estriol
- The initial dose for vaginal menopause symptoms is usually one applicator-dose daily for two to three weeks. The maintenance dose is one applicator-dose twice a week
- Your doctor may recommend you to stop Ovestin every two to three months for a period of four weeks. This is usually to assess the need for further treatment
Gynest – Gynest is a vaginal cream that contains estriol (oestrogen):
- It is prescribed for post-menopausal women in the following – vaginal dryness and soreness, difficult or painful sex, itchiness of the vulva (the external skin of the genitals), kraurosis (shrinking of the skin of the vagina and vulva with a deep chronic inflammation)
- Each gram of cream contains 0.1 mg of estriol
- Gynest is 10 times weaker than Ovestin
- The cream is applied with the use of an applicator The initial dose is one applicator full daily. The maintenance dose is usually one applicator full twice a week
- Your doctor may advise you to stop treatment at three to six month intervals Your doctor may also examine you physically to assess the need for further treatment
Tibolone – Tibolone is synthetic steroid that is classed as a noretynodrel derivative.
- It is prescribed for symptoms in post-menopausal women or to prevent osteoporosis in post-menopausal women who are likely to have bone problems and where other treatments are not tolerated or contra-indicated
- It mimics the activity of oestrogen and progesterone and also has some weak male hormone (androgen) activity
- Each tablet contains 2.5 mg of tibolone and is taken daily by mouth preferably at the same time each day
- Its effects and benefits are similar to combined HRT
- It is also available on prescription under the brand name, Livial
Improved quality-of-life – HRT provides an important and positive improvement to your quality of life if your symptoms are debilitating and affecting your daily life. HRT does come with some risks and it is important to discuss both the benefits and risks with your doctor.
Reduced health risks from menopause – recent clinical studies have suggested that starting HRT in women going through the menopause, provides a ‘window of opportunity’ to additionally reduce the risk of:
- Coronary heart disease and death from heart disease in women between 50 – 59 years of age
- Osteoporosis and death from hip fractures
If you’re around the right age for menopause and you notice some of the signs then you might want to consider treatment. Menopause causes a range of physical and emotional symptoms that affect various parts of your body. HRT is most commonly prescribed to relieve ‘vasomotor symptoms’. They are caused by a temperature dysfunction in your body as a result of the declining sex hormones. They include the following:
- Night sweats – can be severe enough for you to change your bedding or clothes
- Excessive sweating during the day
- Hot flashes – warmth or intense heat on the face, neck, chest (it can spread to the rest of the body and you may feel ‘chilly’ after)
- Hot flushes – warmth or intense heat with redness of the skin (similar to blushing)
Vasomotor symptoms usually interrupt your sleep, which can lead to other symptoms such as:
- Mood changes – irritability, depression, anxiety
- Poor memory or concentration
- Heart palpitations or a fast heart rate – these can also occur with hot flushes
Symptoms related to your reproductive and urinary organs include the following:
- Shortening and tightening of the vaginal canal
- Vaginal dryness, itching or burning
- Discomfort or pain after sex
- Low or loss of libido (sex drive)
- Pain or burning when passing urine
- The need to pass urine urgently or more frequently
- Recurrent urinary tract infections
- Urinary incontinence (involuntary leakage)
Symptoms may also occur over a longer period of time and may not always be noticed early. They include the following:
- General aches and pains in the joints or muscles - these can occur anywhere in the body such as hands, neck, back, knees or ankles
- Irregular periods – the length of time between each period may become shorter or longer (maybe even months apart)
- Heavier periods
- Weight gain
- Hair loss
- Dry, thin or itchy skin – menopause causes some loss of your skin protein (collagen)
When should I start HRT? – women can consider using HRT if their symptoms are seriously affecting their daily life.
You should consider starting before you’re 60 – current research indicates that you should start thinking about HRT treatment before the age of 60 or within 10 years of your menopause as this time frame indicates the most benefit in comparison to the risks. This time frame is also more likely to be associated with a reduced risk in coronary heart disease and death from heart disease.
Women over 60 do not usually start HRT. Research and the likely benefit for HRT in women over 60 is limited. Speak to your doctor for more advice as you may be able to use a low dose HRT patch.
It’s best to figure out on an individual basis – current advice is that unpredictable limits should not be placed on the duration of HRT treatment. If your symptoms still persist, then the benefits usually outweigh the risks. It is always important to have regular reviews with your doctor and to discuss how long you should be taking HRT if you are unsure.
HRT can cause some side effects as with any other medicine.
Most go away quickly – it takes some time for your body to get used to HRT. If you do experience any side effects, they usually settle within the first few weeks. Speak to your doctor if they persist for more than three months or are particularly troublesome. Your doctor may suggest a different type of HRT or change your dose.
If after four to six months you have not felt any benefits, then speak to your doctor. Switching to a different type of HRT may be beneficial.
Some possible side effects are:
- Nausea – this is can be reduced by taking your tablet at night with food.
- Irregular bleeding or spotting – this is common in the first few months of a sequentional treatment. Speak to your doctor if this continues for more than six months or occurs when you take a continuous combined treatment
- Pre-menstrual symptoms
- Breast tenderness and enlargement
- Skin irritation – this is more common with patches. Sometimes they can fall off
- Acne or greasy skin
- Water retention – speak to your doctor if you feel you are gaining weight because of water retention
- Pain in the lower stomach
- Leg cramps
Seek immediate medical attention or visit your nearest A&E if you experience any of these rare but serious effects:
- Blood clots (including sharp chest pain, sudden breathlessness or pain and swelling in the legs)
- Heart attack (including chest pain radiating to the arms, face or jaw, fainting, shortness of breath)
- Stroke (sudden numbness of one side of the body, sudden trouble seeing, speaking or walking) – unexplained migraine-type headache with or without disturbed vision may be an early warning sign of a stroke
- Allergic reaction (face, mouth or throat swelling or difficulty breathing)
- Severe liver problems (including yellow eyes or skin)
The information leaflet with your HRT medicine will provide more specific information about how to take your HRT, associated risks, interactions, side effects and any contraindications.
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