What is hormone replacement therapy and how is HRT used to treat women going through menopause?
MANY women of menopausal age are likely to have heard those three letters "HRT", but have no clue what it actually is and if its for them.
The menopause can be a confusing time as it is, with symptoms generally starting from the mid-40s and lasting years on end.
The experience can range from person to person - while some lucky few will have no problems with the "transition", others will experience symptoms so debilitating that it changes their life.
Those who are struggling may benefit from HRT (hormone replacement therapy), which is used to relieve the symptoms such as hot flushes, mood swings, vaginal dryness and night sweats.
In fact, many women say that it changed their life.
But, due to misinformation spanning decades, many women may fear using HRT, and doctors can be reluctant to prescribe it.
It means millions could be missing out on HRT, regarded as the most effective way to medically treat menopause symptoms.
The Sun's Fabulous Menopause Matters campaign was launched in October 2021 to empower women to demand the healthy menopause they deserve, calling for free HRT for everyone.
Here we explain what the treatment is, why it needs to be more accessible, and whether you or someone you love could benefit...
What is hormone replacement therapy?
HRT is a treatment which uses oestrogen and progesterone to relieve menopausal symptoms.
These are the two main hormones that naturally deplete during the menopause.
Treatment involves taking either both (combined HRT) or oestrogen-only HRT, depending on the women's needs.
As the therapy replaces the hormones that the body is lacking, it’s considered to be one of the most effective remedies for ailments including:
- Hot flushes
- Night sweats
- Mood swings
- Vaginal dryness
- Reduced sex drive
There are different ways of taking HRT and it can be administered through tablets, skin patches, gels and vaginal creams, pessaries or rings.
Who can take HRT?
Hormone replacement therapy is widely available to those who are battling menopausal symptoms.
The NHS outlines those who may not be suitable for the treatment. This includes:
- Patients with a history of breast cancer, ovarian cancer or womb cancer
- Patients with a history of blood clots
- Patients with untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
- Patients with liver disease
- Pregnant patients – it's still possible to get pregnant while on HRT, so you should use contraception until two years after your last period if you're under 50 or for one year after the age of 50
In any case, you should talk to your GP or menopause specialist about if HRT can work for you. There are so many options that it's possible something can be worked out.
How can you get started on HRT?
Call your surgery and ask to see another GP – ask for one with interest in women’s health or menopause. Most practices have at least one GP with extra qualifications or an interest in these areas.
It's worth keeping a diary of your symptoms for a while so that you can take them to your GP and give a clear explanation of when they occur, and how this affects your life.
After discussing your symptoms, the doctor will then explain the different types of hormone replacement therapy available to you.
If you meet the criteria of patients who can have HRT, your GP will then start you off on a low dose of the hormones.
Patients are typically urged to try the treatment for three months to see whether or not it works.
Often, your progress will be monitored in follow-up appointments to check that there aren’t any concerning side-effects.
Don't be afraid to get a second opinion from another GP if you don't feel listened to.
However, be wary that you may go into the doctors expecting to be given a HRT prescription, but be told it is not suitable for you based on your medical history or otherwise.
How much does it cost?
Unlike other hormone treatments like the Pill, women have to pay for HRT.
Women in England have to pay £9.35 for every NHS prescription they need, or £18.70 if they need two types of hormones. It is often provided on a short-term basis, meaning the cost has to be paid every month or every three months.
This leaves many women unable to afford it, while those living in Scotland and Wales get their HRT for free.
But in October 2021, the Government backed a "menopause revolution" as ministers pledged to cut the cost of repeat prescriptions of HRT.
After politicians and celebs joined The Sun's Fabulous Menopause Matters campaign, women on repeat prescriptions will only have to pay one charge of £18.50 a year - saving up to £205.
MP Carolyn Harris, who introduced the initial bill, wept as commitments were made to help women struggling with symptoms and costs of the menopause.
The government is holding discussions with NHS England to put the measures into practice.
Meanwhile, health watchdogs are set to announce that HRT will be sold without a prescription for the first time.
The Medicines and Healthcare products Regulatory Agency are preparing to put forward a reclassification of HRT that would see women be able to buy them over the counter, The Daily Telegraph reported in February 2022.
Are there any negative side-effects with hormone replacement therapy?
HRT gets a bad rap. Fears mostly stem from a flawed study that was done in the US and published in 2002 that said HRT can cause breast cancer.
In a HRT myth busting piece for The Sun, GP Dr Philippa Kaye said: "For the general population, there are potential risks with HRT but these are small and some can be mitigated by how the HRT is delivered.
"In general, for women between the ages of 50 and 60, the benefits of starting HRT hugely outweigh the risks. For women between 60 and 70 the benefits and risks of starting are approximately balanced and for women over the age of 70, the risks of starting HRT tend to outweigh the potential benefits.
"HRT doesn’t suit everyone if you have what are called 'contraindications'.
"Each case is different, so speak to your GP."
Research has suggested the HRT can lead to a small increase in the risk of serious ailments, including blood clots and breast cancer.
For example, combined HRT is shown to increase the risk of breast cancer from 23 cases per 1,000 to 27 per 1,000 - so the risk is very small.
These are the sorts of things that you discuss with your GP to weigh up the risks and benefits for you.
Taking medication of any sort can cause side-effects on the body – but often these stabilise after a three month period.
Those who start on HRT may suffer increased breast tenderness, headaches, nausea, indigestion and vaginal bleeding.
It’s important to visit your GP if you’re concerned about these side-effects, or if they continue past the three month period.
What are the benefits?
On the other hand, there are huge benefits to HRT besides giving women a better quality of life.
For example, a 2017 study claimed that women on hormone replacement therapy tend to live longer, with the treatment cutting the risk of overall death by 30 per cent. This was backed by another study in 2021, that showed HRT cuts the risk of dying young by nine per cent.
Taken over a long period, HRT can decrease the risk of osteoporosis, where the bones become thin and fragile.
Many women, including celebrities, have revealed how HRT has changed their life.
As part of The Sun's Fabulous Menopause Matters campaign, Lisa Snowdon revealed how HRT stopped her from having menopausal rages and screaming at her man.
The presenter and model said the drug was a "gamechanger" after years of struggle.
Liberty X singer Michelle Heaton also revealed that the menopause left her feeling "suicidal". But since feeling the impact of HRT, she said:
“The HRT is just banging now. I can’t believe those suffering women out there who aren’t armed with the facts about HRT and how beneficial it can be."
BBC presenter Kirsty Wark said in February 2017 that she endured a "hard menopause" after ditching HRT over cancer fears.
Are there alternative treatments available other than HRT?
If your menopausal symptoms are causing you discomfort or occur before the age of 45, your GP may be able to help.
If Hormone Replacement Therapy doesn’t seem like the right option for you, there are alternative treatments available.
In severe cases, your GP may offer...
- Vaginal creams or lubricants for vaginal dryness
- Cognitive behaviour therapy (CBT) which can help with anxiety
- Tibolone is another medication that’s similar to combined HRT, but this will only work for women who had their last period more than a year ago
- Clonidine is sometimes prescribed to reduce hot flushes and night sweats, although the benefits are limited
- Your GP may also advise you to make changes to your lifestyle – including regular exercise, eating healthily and cutting back on coffee, alcohol and smoking