Hormone Replacement Therapy
Hormone replacement therapy (HRT) is the most effective and widely used treatment for menopausal symptoms. As its name suggests, it’s simply a way of replacing the hormone oestrogen that’s lost during the menopause.
HRT aims to relieve those symptoms related to oestrogen deficiency, such as hot flushes, vaginal dryness and osteoporosis. The benefits of HRT as a remedy for hot flushes, sleep disturbances, vaginal symptoms and some mood disorders have been proved. Some women experience unwanted side effects when taking HRT for the first time. These may include breast tenderness, leg cramps, nausea, bloating, irritability and depression. Usually these symptoms resolve after a few months, but a change in route/type (oral/tablet, transdermal/patch or gel) or dose of HRT may be required to find a combination that’s right for you.
Although there have been concerns raised about HRT and the potential risks to various aspects of women’s health, the latest evidence – as reflected in current clinical guidelines – shows that although not entirely risk-free, HRT remains the most effective solution for the relief of menopausal symptoms and is also effective for the prevention of osteoporosis. It may also provide protection against heart disease in certain age groups.4
For anyone thinking about starting HRT, the recommendation is to discuss the benefits and risks of HRT with your GP on an individual basis. Overall, the balance of benefit to harm always needs to be assessed, but appears to have shifted favourably for HRT as we gather more evidence. Women using or hoping to use HRT can usually be reassured, provided:
- HRT is taken for the correct reasons, i.e. to alleviate the symptoms of the menopause.
- HRT is taken for only as long as necessary - usually up to five years is considered safest at the lowest effective dose.
- HRT users are assessed by their GP at least once a year.
If you’re thinking of starting HRT and you still have your uterus you will be given progesterone alongside your oestrogen therapy to prevent the lining of your uterus from thickening and potentially becoming malignant. By adding progesterone this risk is negated. The progesterone can be given either continuously or cyclically.
If women start HRT around the time of menopause the associated risks are very small, however there is only limited data for continued usage beyond the age of 60. It is not usually appropriate for women over 60 to be starting HRT. As a large Womens Health Initiative study showed, the risks are increased, but this does not mean that women who started HRT earlier should have to stop it on reaching 60.4
In recent years, practitioners in some areas have begun to prescribe bio-identical hormones for relief of menopausal symptoms. These are man-made hormones, usually of plant origin and designed to be identical to those produced naturally by the body. They are available as creams, lozenges, gels and vaginal preparations. They frequently contain a mix of several differing types of oestrogen, progesterone and other sex hormones produced by the body, however there are currently no long-term studies that have been performed on these preparations to look at efficacy and risk. They are not regulated by the MHRA and are marketed as natural products. This means they haven’t been through the rigorous process of drug development, which conventional medicines and products usually undergo and therefore haven’t been scientifically evaluated in clinical trials for effectiveness and safety.
Complementary and alternative therapies
These have become a popular choice and many women use them, although limited scientific research has been done to support their effect or safety. They may sometimes help with troublesome symptoms, but are unlikely to have a significant impact on bone strength, the heart or blood vessels.
Choosing a complementary or alternative therapy can be a challenge as there are so many. Acupuncture, aromatherapy, herbal treatments, homeopathy, hypnotherapy, yoga and reflexology have all been reported as being helpful during menopause. Use of vaginal lubricants can also help to overcome vaginal dryness and soreness in some women.
Black cohosh and red clover extract have been found to be effective in helping to relieve certain menopausal symptoms and unlike some other supplements, have been subjected to research trials.6 In the case of red clover extract, it does need to be taken for six to nine months before it’s full effectiveness can be felt, so you need to be patient, but it can be worthwhile persisting with.
As with any dietary supplements, you should always consult your GP before taking them to make sure they’re safe for you.
- Menopausal women may feel overwhelmed with the type of symptoms they experience leading up to and during the menopause, but it’s also a time that can inspire us to make positive changes for a healthy and productive future. If you’re going through the menopause, take time to do something that makes you happy every day, even if it’s only for ten minutes. Read, dance, listen to your favourite music, speak to a friend or go for a run – whatever it is that lifts your mood, make sure to schedule it in.
- If your you-time involves getting active, try to also factor in time out for relaxation, whatever form it takes - yoga, meditation, walking in the countryside or taking a relaxing bath, these all help to reinforce your mental health.
- Nutrition: revisit your dietary habits. Try to eat a low saturated fat, low salt diet and plan on incorporating healthy foods, such as fresh fruit and vegetables, lean fish, poultry and meat, seeds, nuts and healthy fibre. Make sure to include extra vitamin D, found in oily and fatty fish, cheese, egg yolks and foods fortified with vitamin D. Also include foods rich in calcium to help maintain healthy bones. These include dairy products, green leafy vegetables, soy beans and tofu. The last two foods are also phytoestrogens, which are plants that have some oestrogenic effects in the body.
- Exercise: aim to have at least 150 minutes of aerobic exercise a week. This could include swimming, cycling, running, dancing or an exercise class. Remember that it’s important to find an activity you enjoy so it doesn’t feel like a chore. And also try to incorporate weekly strength training into your activity, to help build bone strength and keep muscles healthy.
- If you’re battling with your symptoms, start to keep a symptom diary and make a note each day of how you’re feeling, scoring any symptoms according to how bad you’re finding them. This can help form the basis of a chat with your GP or menopause specialist to discuss your symptoms and look at ways these can be managed and treated.
- Although mood changes are common with the menopause, if you find that the self-care techniques discussed in this article aren’t enough to lift your mood or help manage your anxiety and you prefer not to, or aren’t able to take HRT, don’t be afraid to ask for help through counselling or therapy and also from your GP.
- Read up about the menopause and its management as much as possible. Being well-informed helps put you in control of what’s happening to you, and speak to your GP about any symptoms that are affecting you badly.
- If hot flushes are a particular problem, try to keep cool sheets on the bed with a blanket to hand for when the flush has stopped. Wearing natural fibres, like linen and cotton, can help you stay cool. Hand held and desk fans in your environment can also be invaluable, as can carrying a cooling facial mist spray when you’re out and about.
- Energy can dip at this time, due to sleeplessness resulting from menopause symptoms, as well as other changes caused by the menopause itself. Take time for a nap when you can andtry to build in time to relax and recharge if possible. Our article on how to fight fatigue and boost your energy contains more information and tips you may find useful.
- Skin: you may notice your skin becoming drier and thinner during and after the menopause - this is usually due to a loss of elasticity and collagen, caused by low oestrogen levels. Try to treat your skin to daily moisturising face and body creams or lotions, to help nourish and support your skin’s elasticity and reduce dryness.
- Above all else don’t be afraid to talk about what is happening to you, whether it’s with your partner, your GP, employer, a trusted friend or a group of friends, or via the online resources and forums available to you, including your EAP (Employee Assistance Programme), if you have one. Asking for support and sharing your experience with others can be powerful steps towards managing your symptoms and coming out the other side stronger, healthier, more positive and better equipped to live your life to the full, for many more years to come.
You may find these articles and other AXA Health resources helpful:
Fit more activity into your lifestyle
How to fight fatigue and boost your energy
Managing the menopause
Osteoporosis and bone health
Mental health hub
The following resources are available for more news, information and support for those experiencing, or affected by, menopause:
Menopause matters – an independent website providing up-to-date, accurate information about the menopause, menopausal symptoms and treatment options. Additional support includes fitness routines, tailored for the menopause. a forum to enable you to connect with others and free quarterly newsletter.
Menopause support – a patient expert led not for profit organisation that aims to provide every woman with access to factual, evidence based, non-biased information, education, advice and emotional support to empower them to take control of their health and well-being during menopause and beyond. 1-2-1 support is also available (at a cost) via telephone and video call, or connect with others through closed Facebook group the Menopause Support Network.
Women’s health concern – this patient arm of the British Menopause Society provides a confidential, independent service to advise, reassure and educate women of all ages about their gynaecological and sexual health, wellbeing and lifestyle concerns, via the website, by telephone/email and in live and online events.
Diet and the menopause - The Association of UK Dieticians.
Official guidance on the benefits and risks of HRT - National Institute for Health and Care Excellence (NICE) website.
Our health and wellbeing pages are written and regularly reviewed by appropriately qualified medical experts. The content is based on medical evidence and guidelines available at the time of writing.
It is not intended to be a substitute for professional medical advice given in the context of an individual consultation. Nor should it be used to self-diagnose or recommend a course of treatment.
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1. In a 2017 survey on behalf of the British Menopause Society, Edelman Intelligence conducted online interviews with 1,000 adults in the UK (698 women and 302 men) who were aged 45+ and either peri-menopausal, menopausal or post-menopausal or partners of those who are, nationally representative of the online population in terms of regional spread.
2. Ogita H, Node K, Kitakaze M. The role of estrogen and estrogen-related drugs in cardiovascular diseases. Curr Drug Metab. 2003;4(6):497-504. doi:10.2174/1389200033489271.
3. Office for National Statistics. Leading causes of death, UK: 2001 to 2018. Registered leading causes of death by age, sex and country. Last updated: 27 March 2020 [Accessed 20 August 2020].
4. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. The Lancet, vol 394, issue 10204, p1159-1168, September 28, 2019.
5. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-333. doi:10.1001/jama.288.3.321.
6. Geller SE, Studee L. Botanical and dietary supplements for menopausal symptoms: what works, what does not. J Womens Health (Larchmt). 2005;14(7):634-649. doi:10.1089/jwh.2005.14.634