Menopause and HRT treatment

Hormone Replacement Therapy (HRT) is a treatment available to women who have menopause-related symptoms. 

If you mainly have genital symptoms such as vaginal dryness or bladder symptoms, you may choose to try a topical (vaginal) HRT treatment, also known as vaginal oestrogen cream or vaginal oestrogen tablets. However, if you have other symptoms of menopause such as hot flushes or sweats, you may want to consider HRT tablets or patches that work on the entire body. 

Testing for the menopause – if you’d like to check whether you are menopausal and might be ready for HRT, you can order a home test kit.

What is Hormone Replacement Therapy (HRT)?

The menopause can cause some unpleasant symptoms, including:

• Hot flushes
• Mood swings 
• Night sweats
• Reduced sex drive (low libido)
• Sleeping difficulties

HRT can help – severe menopausal symptoms can interrupt with everyday life, so it is important to seek treatment, so you can carry on with your daily activities. The symptoms which women mostly complain about are hot flushes and sweating, improvements in these can help to improve their quality of life.

HRT involves replacing natural hormones – most women take a combination of the oestrogen and progestogen hormones, while women who have had a hysterectomy and have no womb can take oestrogen on its own. The primary aim of HRT is to ‘top-up’ the body’s natural supply of hormones which stop being produced during the menopause.

The two main types of HRT are:

• Oestrogen-only HRT:
• For most forms of HRT – it is normally used in women who have had their womb removed don’t need progestogen, a hormone which protects the lining of the womb
• For vaginal HRT – it can be used by women with a womb and doesn’t include progesterone because it is applied locally to the vagina
• Combined HRT
• Involves a combination of oestrogen and progesterone
• Continuous combined HRT – includes taking the hormones together once-daily for 28 days continuously, doesn't include a withdrawal bleed
• Sequential combined HRT – includes taking oestrogen for 14 days, then both hormones for a further 14 days, results in a monthly withdrawal bleed

What is Menopause?

Menopause refers to the last menstrual period in a woman’s life, and it occurs due to loss of ovarian follicular activity.  This can be defined once a woman has gone for 12 months without a period.

What causes menopause?

Menopause occurs when the supply of responsive oocytes (early eggs) is exhausted.  Therefore the ovaries no longer release a monthly egg, and oestrogen levels (released by the ovaries) fall.

What age does menopause start?

The average age of menopause in the UK is 51. However, the period before menopause (called perimenopause), when women may experience menopausal symptoms, can begin some years before this.

What are the early signs of menopause?

Women will often note a change in their menstrual cycle to be the first sign of menopause/perimenopause.

What happens during menopause?

After the last menstrual period, oestrogen production from the ovaries falls, which causes changes in levels of other hormones released from the brain.  The change in hormone levels can cause a wide variety of symptoms and affect a woman’s bone and cardiovascular health.

What Are The Symptoms Of Menopause (including Worst Symptoms)?

Symptoms can be...

vasomotor:

• hot flushes
• night sweats 

psychological: 

• low mood
• mood swings
• irritability
• low lidido 

genitourinary: 

• urinary frequency 
• recurrent cystitis
• vagina dryness

It can also cause poor sleep, headaches, achy joints and dry or itchy skin.  The severity of symptoms will vary between women, but many report severe sleep disruption as one of the most challenging symptoms experienced.  

How does menopause change the brain?

Research is still ongoing into the effects of oestrogen deficiency and replacement on cognition.  Many women do complain of poor memory or ‘brain fog’. It is uncertain if this is a direct effect or a knock on effect from other symptoms (such as poor sleep).  There is ongoing research into menopause, hormone therapy, and later dementia or Parkinson’s disease.

How long does menopause last?

On average, menopausal symptoms last for 4 years after your last period.  Some studies suggest symptoms can start three years before this point, giving an average duration of symptoms of seven years.

What are the signs of menopause coming to an end?

Menopause itself is a point in time that refers to your last menstrual period. If we look at menopause as a symptomatic phase that passes with time, the reduction in severity and frequency of symptoms indicates the symptomatic phase is coming to an end.

How to delay menopause?

There is evidence to show that smoking reduces the age of menopause,  so stopping/avoiding smoking may help prevent earlier menopause. Having children and using contraception that suppresses ovulation is associated with later menopause.