Menopause and Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is one of the most widely discussed and sometimes controversial treatments for menopause. In Australia and New Zealand, it is also referred to as Menopausal Hormone Therapy (MHT). Before considering HRT, it’s important to speak with your doctor or gynaecologist, who can help determine if this treatment is right for you, based on your medical history, symptoms, and overall health. A list of menopause care providers is available in the additional resources section.

This article provides general information about HRT to help you better understand how it works and how it might help manage menopause symptoms.

Understanding HRT

The transition to menopause, which is marked by 12 consecutive months without a period, brings significant hormonal changes. These changes are the primary cause of the symptoms that many people experience during menopause.

HRT is a medical treatment that involves taking hormones to replace those that the body no longer produces in sufficient amounts during menopause. The two main hormones used in HRT are oestrogen and progesterone, although sometimes only oestrogen is prescribed—particularly for those who have had a hysterectomy.

• Oestrogen: Oestrogen plays a critical role in regulating many bodily functions, including controlling the menstrual cycle and maintaining bone density. As oestrogen levels decline during menopause, common symptoms such as hot flushes, night sweats, vaginal dryness, mood swings, and sleep disturbances can occur. By restoring oestrogen levels through HRT, many of these symptoms can be alleviated or even eliminated.
• Progesterone: Progesterone is often used alongside oestrogen to protect the uterus from the potential risks associated with unopposed oestrogen therapy. It helps prevent the overgrowth of the uterine lining, reducing the risk of endometrial cancer. People who have had a hysterectomy do not require progesterone because there is no uterus to protect.

Forms of HRT

HRT can be administered in various forms, including:

• Tablets: Oral tablets are a common and convenient option.
• Patches: Transdermal patches are applied to the skin.
• Creams and Gels: These are applied directly to the skin.
• Vaginal Rings or Creams: These can be used specifically for vaginal dryness or discomfort during intercourse.

The delivery method is selected based on individual preferences, medical history, and the symptoms being treated. For example, vaginal oestrogen creams or rings may be recommended for people experiencing vaginal dryness.

Potential Risks and Side Effects

While HRT is highly effective for managing menopause symptoms, it is not without potential risks. Before starting HRT, it is essential for individuals to have a thorough discussion with their healthcare provider to assess personal health risks and benefits. Some medical conditions or a family history may make HRT less suitable. Prolonged use of HRT may increase the risk of certain health issues, such as breast cancer, blood clots, and stroke.

In Australia and New Zealand, it’s advised that HRT may not be appropriate for individuals who:

• Have a history of breast cancer, ovarian cancer, or womb cancer
• Have a history of blood clots (in which case, patches or gels may be recommended instead of tablets)
• Have untreated high blood pressure (blood pressure must be controlled before starting HRT)
• Have liver disease
• Are pregnant (as it is still possible to conceive while using HRT, contraception should be used until 2 years after the last period if under 50, or for 1 year if over 50)

Monitoring and Lifestyle Modifications

HRT is not a one-size-fits-all treatment. Its benefits and risks can vary from person to person, so regular check-ins with a healthcare provider are essential to ensure the treatment remains effective and appropriate. Additionally, lifestyle changes can complement HRT and improve overall well-being during menopause. Maintaining a balanced diet, staying active, managing stress, and ensuring quality sleep can all play significant roles in enhancing health during this time.

Conclusion

Hormone Replacement Therapy (HRT) can be an effective treatment for managing menopause symptoms, such as hot flushes, night sweats, mood swings, and vaginal dryness. However, it is vital to have an open and thorough discussion with your healthcare provider to assess the potential risks and benefits based on your individual health profile. With the right guidance and ongoing monitoring, HRT can be a valuable tool in managing menopause symptoms and improving your overall quality of life.