Menopause and HRT

This information sheet has been designed to answer some of the questions you might have about the menopause and its treatments. We recommend reading it before seeing your GP to help you get the most out of your appointment.

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What is the menopause?

The menopause is the stage of a women’s life when she stops having periods and her ovaries stop releasing eggs. We say a woman has been through the menopause after not having any periods for one year. It commonly happens at around 50 years of age but every woman is different and it can occur earlier or later. The time leading up to the menopause is called the peri-menopause. During the peri-menopause a woman’s ovaries produce less and less of a hormone called oestrogen. Lower oestrogen levels can result in some woman experiencing a range of symptoms and most common are hot flushes and night sweats.

How do I know when I am peri-menopausal?

The peri-menopause is associated with a change in your periods. Periods often become less regular. Approximately two thirds of women also experience other physical and/or emotional symptoms such as:

Every woman is different – some women experience a lot of symptoms and others very few. Some women’s symptoms are short-lived, lasting just a few months, but some women may have symptoms for many years. 

Do I need a blood test?

The menopause is diagnosed by symptoms, especially changes with periods and so the majority of women do not need to have a blood test to check their hormone levels. 

If a woman is less than 45 years old she might be offered a blood test if it is suspected that she could be going through an early menopause. Early menopause is diagnosed if a woman has two blood tests six weeks apart both showing abnormal hormone levels.

The blood test is not accurate in women taking some hormone-based contraceptives. Your doctor will check to see if this applies to you.

Do I need treatment for the menopause?

No – the menopause is a natural stage of a woman’s life and although some women may choose to have treatment, not all women feel they need it. Some women make lifestyle changes to manage their symptoms such as regular exercise, wearing light clothing and ensuring good sleep hygiene. Other women see their doctor for medication such as Hormone Replacement Therapy (HRT). This is a personal decision that you can discuss with your doctor.

What is HRT?

HRT is a medication to top-up a woman’s oestrogen levels.  By increasing oestrogen levels, it reduces symptoms caused by low oestrogen levels as listed above.

There are two main types of HRT:

1. The first type is oestrogen-only HRT. This is for women who have either had a hysterectomy (so no longer have a womb) or have a Mirena coil (which protects their womb). These women only need one hormone (oestrogen) to be replaced.
   
2. The second type is Combined HRT. This is for women who have not had a hysterectomy and do not have a Mirena coil. The oestrogen is still replaced but it is combined with another hormone called progesterone in order to protect the lining of your womb. 
   
   There are two types of Combined HRT:

• Continuous Combined HRT – this is used if you and 50 years of age or older and your periods have stopped completely for a whole year. You take this HRT every day and get no monthly bleeds.
  
• Sequential Combined HRT – this is used if you are still having periods. Here you take oestrogen only for 14 days and then both oestrogen and progesterone for 14 days and most women on this regime continue to have monthly bleeds. 

How do I take HRT?

There are different ways of taking HRT available and your doctor will help you decide the most suitable route for you. 

Options include:

1. Tablets – these tablets contain either oestrogen and progesterone or oestrogen alone and are taken once a day and they come in different strengths.
   
2. Patches – these patches contain either oestrogen and progesterone or oestrogen alone and are applied once or twice weekly and they too come in different strengths.
   
3. Gel – this non-greasy gel contains oestrogen only and is applied daily to skin on the shoulder, upper arm or inner thigh.  It takes a few minutes to dry.
   
4. Vaginal creams, tablets, and pessaries – these all contain oestrogen only and they work locally in the vagina to treat vaginal dryness. They do not improve other symptoms such as night sweats and hot flushes but can be very helpful in preventing cystitis and recurrent urine infections. They have fewer risks and fewer side effects compared with the other forms of HRT, including no increased risk of breast cancer. They are therefore safe to use for long-term.

What are the advantages of HRT?

The main advantage of HRT is that it is the most effective method of improving the majority of symptoms a woman can experience during the peri-menopause. Whilst taking HRT, it can also help to improve bone density and sometimes muscle strength too.

What are the disadvantages of HRT?

Most women tolerate HRT very well, however some women can experience side effects such as:

As well as side effects, are there other disadvantages of HRT?

There are a few risks association with taking HRT, which include:

• A small increase in the risk of blood clots which can get lodged in the blood vessels of your legs and lungs. The extent of this risk depends on other factors such as your age, weight and whether you are a smoker. This risk is mainly associated with HRT taken as tablets and less so with patches and gels.

• A small increase in the risk of having breast cancer but no increase risk of dying from breast cancer. The extent of this risk depends on your age and the length of time you take HRT. This risk decreases once HRT is stopped.

• We do not recommend starting HRT in women over the age of 60 due to the increased risk of coronary heart disease and strokes.

Does HRT work straight away?

Every woman is different but on average people start to notice the beneficial effects after three weeks of using HRT. It can take three months before maximum benefit is felt.All women are reviewed after three months of taking HRT. Sometimes the strength of HRT has to be adjusted.

How long should I take HRT for?

The length of time HRT is taken for depends on how long your menopausal symptoms last. Usually women take it for two to five years and then it is stopped gradually.

Does HRT also work as contraception?

No – although periods usually become less frequent in the lead up to the menopause it is still possible to become pregnant and contraception is therefore still required. Pregnancy during this stage of life can carry higher risks. All women including those on HRT require additional contraception if they do not want to become pregnant. The only exception to this is women who have a Mirena coil as part of their HRT which is effective contraception.

I was told not to take combined oral contraceptive pills – does that mean I cannot use HRT? 

No – some women are advised not to take combined oral contraceptive pills because they experience migraines. HRT is a much lower dose of hormones and so it can safely be used in patients who have migraines.

Is there anything I should avoid?

Yes – some therapies interact with HRT. This includes certain over-the-counter complementary therapies such as St John’s Wort and Black Cohosh and some prescribed medication such as drugs used in managing epilepsy. Your doctor will check which medication you are on before prescribing HRT.

How much does HRT cost?

HRT is only available on prescription. It is free if you have an exemption certificate otherwise for people age under 60 years it costs £8.60 per medicine which lasts for 4 weeks. HRT consists of either one or two medicines depending on which regime is most suitable for you.   

Are there any alternatives to HRT?

Yes – some of the alternative options include:

• Lifestyle changes,such as exercising, eating a healthy diet, reducing caffeine intake, staying cool at night, reducing stress and stopping smoking

• Antidepressant medication – these can help with mood changes,night sweats and hot flushes

• Vaginal lubricants/moisturisers to help with vaginal dryness

• Herbal medicine such as Evening Primrose Oil and St John’s Wort however it is important to be aware that the purity of these products may be unknown

• Self help groups, psychotherapy and counselling which can be helpful with psychological effects of the menopause

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We hope this leaflet has answered some of the questions you might have about the menopause and its treatment. It can be useful to write down any further questions you have and then ask your doctor at your appointment.