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Understanding Hormone Replacement Therapy (HRT) for Menopause

Menopause is a natural phase in a woman’s life, typically occurring between the ages of 45 and 55, marked by the end of menstrual cycles. This transition brings about a significant decline in the hormones oestrogen, progesterone and testosterone, leading to various symptoms that can affect a woman's quality of life.

The perimenopause is the period leading up to your last menstrual period and is often the time when sympotms are worsen due to eratic ovarian function and fluctuating hormne levels. The perimenopause can start in your late 30's and normally lasts somehwere between 2-10 years.

Hormone Replacement Therapy (HRT) is a treatment used to relieve these symptoms by replenishing the body with these hormones. This article explores the benefits of HRT, the different types available.

Benefits of hormone replacement therapy (HRT) in the menopause

HRT can offer a range of benefits for women experiencing menopause:

  1. Relief from Symptoms: The primary benefit of HRT is the alleviation of common menopausal symptoms such as hot flushes, night sweats, mood swings, sleep disturbance, fatigue, anxiety, muscular aches and joint pain and vaginal dryness.

  2. Bone Health: HRT helps in maintaining bone density, reducing the risk of osteoporosis and fractures that increase after menopause due to lower oestrogen levels.

  3. Heart Health: Some studies suggest that HRT can improve heart health by maintaining the elasticity of blood vessels and reducing cholesterol levels, though this benefit is still debated and may depend on the timing of HRT initiation.

  4. Mood and Mental Health: HRT has been shown to help with mood swings, depression, and anxiety associated with menopause, improving overall mental well-being.

  5. Sexual Health: By alleviating vaginal dryness and increasing libido, HRT can enhance sexual function and comfort.

menopause consultation with menopause doctor
Understanding your HRT options

Types of HRT Available in the UK

There are several forms of HRT available in the UK, catering to different needs and preferences:

  1. Combined HRT: This form contains both oestrogen and progesterone, and is suitable for women who still have their uterus. Progesterone is included to prevent the thickening of the womb lining (endometrium), which can occur with oestrogen alone, reducing the risk of endometrial cancer.

  • Tablets: Taken orally, they are a common and straightforward option.

  • Patches: Applied to the skin, they release hormones steadily into the bloodstream.

  • Gels: Applied to the skin, they offer flexibility in dosing.

  1. Oestrogen-Only HRT: Suitable for women who have had a total hysterectomy, as they do not need progesterone.

  • Tablets, patches and gels Similar to combined HRT options.

  • Vaginal Oestrogen: Available as creams, pessaries, or rings, these target vaginal symptoms specifically with minimal systemic absorption.

  1. Sequential HRT: This type is used for perimenopausal women who are still experiencing menstrual periods. Oestrogen is taken continuously, but progesterone is added for part of the month to induce regular withdrawal bleeding.

  2. Continuous HRT: Suitable for postmenopausal women, it involves taking oestrogen and progesterone continuously without breaks, avoiding monthly bleeding.

Body-Identical Hormones

Body-identical hormones, which are chemically identical to those the human body produces, are often preferred due to their perceived safety and efficacy. The most commonly used body-identical hormones in the UK include:

  • Oestrogen: 17-Beta-Estradiol (available in tablets, patches, gels, and implants).

  • Progesterone: Micronised progesterone (available in capsules, such as Utrogestan).

Considerations and Risks

While HRT has many benefits, it’s important to consider potential risks and discuss them with a healthcare provider. These may include:

  • Breast Cancer: Some studies indicate a slight increase in the risk of breast cancer with prolonged use of combined HRT.

  • Blood Clots: There is a small increased risk of developing blood clots with oral forms of HRT.

How long does it take for HRT to work

The time it takes for Hormone Replacement Therapy (HRT) to work can vary depending on several factors, including the type of HRT, the individual's response to treatment, and the specific symptoms being targeted. Here’s a general overview based on different aspects of HRT:

Immediate Effects:

  1. Symptom Relief: Some women may experience immediate relief from certain menopausal symptoms shortly after starting HRT. For instance, hot flushes and night sweats may improve within days to weeks of starting treatment.

Short-Term Effects:

  1. Vaginal Dryness: Symptoms like vaginal dryness and discomfort during intercourse can improve relatively quickly with local oestrogen treatments (creams, pessaries, rings).

Medium-Term Effects (Within a Few Weeks to Months):

  1. Mood Swings: Improvement in mood swings, anxiety, and irritability can often be noticeable within a few weeks to a couple of months of starting HRT.

  2. Sleep Disturbances: Better sleep patterns may emerge as hormonal balance is restored, usually within a few weeks.

Long-Term Effects (Several Months to Years):

  1. Bone Health: The protective effects of HRT on bone density and osteoporosis risk typically become evident over months to years of consistent use.

  2. Skin Changes: Skin elasticity and hydration may improve gradually with the replenishment of hormones.

  3. Heart Health: Cardiovascular benefits, if present, may become more apparent over time, though this area requires careful monitoring and individual consideration.

Individual Variation:

  • Response Time: Responses to HRT can vary widely among individuals. Some women may experience significant relief within a short period, while others may require more time for symptoms to improve.

  • Adjustment Period: It's important to note that adjusting to HRT can involve a period of trial and error, where dosages and types of hormones may need to be tailored to achieve the best results for each person.


HRT can significantly improve the quality of life for many women experiencing menopausal symptoms, offering relief and additional health benefits. With a variety of types available in the UK, women can choose a form that best suits their needs and preferences.

Have a personalised menopause treatment plan developed for your symptoms and needs.

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