HRT replaces the oestrogen that falls at menopause, and it is the most effective treatment for hot flushes, night sweats and the other symptoms that go with them. The risk picture was badly misreported for two decades; the current position is more reassuring and more nuanced than most people have been told.
Oestrogen is the part that treats the symptoms. Given through the skin as a gel, spray or patch, it does not carry the small clot risk that oral oestrogen does — which is why transdermal routes are often preferred.
Progestogen is added for anyone who still has a womb, to protect the womb lining. It can be a tablet such as micronised progesterone, part of a combined patch, or a hormonal coil.
Vaginal oestrogen is a separate thing entirely — a low-dose cream, pessary or ring for vaginal dryness, discomfort and recurrent urinary symptoms. It acts locally, carries essentially none of the systemic risks, and can usually be used long term and alongside systemic HRT.
Hot flushes and night sweats, sleep disturbance, mood changes, joint aches, vaginal dryness and painful sex, and urinary symptoms. It also protects bone density and reduces fracture risk.
It typically takes around three months to judge the effect, and the dose or route may need adjusting more than once. That is normal, not failure.
Oral oestrogen carries a small increased risk of blood clots; oestrogen through the skin does not appear to. Anyone with clot risk factors is usually offered transdermal.
Combined HRT carries a small increase in breast cancer risk that rises with duration of use and falls after stopping. For most women under 60 starting within ten years of menopause, the benefits outweigh the risks — but it is a personal calculation worth having properly with your GP.
HRT is generally avoided with a history of breast cancer, oestrogen-dependent cancer, unexplained vaginal bleeding, or active liver disease or clotting disorders.
Report any unexplained vaginal bleeding, new breast lump, calf pain or swelling, chest pain or breathlessness, or sudden severe headache.
Gel and spray must dry fully before dressing, and should not be applied to the breasts. Patches go on clean, dry skin below the waist, rotating sites.
HRT is not a contraceptive. Contraception is still needed for two years after the last period if under 50, or one year if over 50.
The NHS HRT prescription prepayment certificate covers a year of HRT prescriptions for the price of two — ask us if you pay for prescriptions.
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