A B C D E F G H I J K L M N O P R S T U V W

HORMONE REPLACEMENT THERAPY (HRT) - MENOPAUSE

What is Hormone Replacement Therapy (HRT) ?

The menopause really means the last period that a woman has. The word is more generally used as meaning that period of time it takes for the periods to stop (also called the climacteric). This may last for several years before the last period itself and other symptoms may continue for several years afterwards. Menopausal symptoms include hot flushes and sweats which may occur at night and disturb sleep. The vagina is less well lubricated which may cause problems with intercourse, mild infections and occasional bleeding. Women may notice mood changes and loss of concentration and there may less interest in sex. These symptoms are not always to due the menopause. Changes also occur in the skin and hair. In addition to these symptoms there is a gradual loss of bone thickness throughout the body after the menopause which increases the risk of fractures, especially in the hips, wrists and back. The risk of angina, heart attacks and strokes in women increases after the menopause.

How does Hormone Replacement Therapy (HRT) occur ?

Each woman is born with a limited number of eggs in the ovaries. Each month one of these eggs is released and when the supply of eggs runs out ovulation ceases. The ovary is no longer able to produce female hormones such as estrogen and progesterone and so the normal build up and shedding of the lining of the womb does not take place so menstruation ceases. The usually occurs in the early 50's but a small number of women will undergo a natural menopause before the age of 40. There is a tendency for daughters to follow the pattern of their mother.

Why does Hormone Replacement Therapy (HRT) occur ?

The natural menopause is a normal process. Early failure of the ovaries can also occur after some viral infections and in some auto-immune conditions (where the body makes antibodies, the molecules that the body uses to fight infection, against its own tissues). The ovaries may be destroyed by radiotherapy for cancer of the cervix and by some drugs used in cancer treatment. If the ovaries are removed at hysterectomy there will be an immediate menopause. If the ovaries are not removed at the time of hysterectomy they will still produce hormones even though the periods will have stopped. Although there will be no immediate menopausal symptoms the ovaries tend to stop working 1-2 years earlier in women who have had a hysterectomy than those who have not.

Treatment Involved with Hormone Replacement Therapy (HRT)

Treatment does not have to be given. If it is, it may be to treat symptoms described above or to prevent future problems. The treatment is usually described as hormone replacement therapy (HRT). As a preventative it is best started before the menopause. The advantages of HRT are that it will prevent the symptoms of the menopause developing. There will be no hot flushes, and some parts of the ageing process are delayed. It will also prevent or delay the development of osteoporosis. Your doctor may check your bone density, to see if you are at particular risk from osteoporosis. This is a thinning of the bones which occurs after the menopause and may lead to back pain and fractures of the wrist and hip in the elderly. HRT also appears to reduce the risk of heart attacks and some types of stroke. There is no doubt that HRT does give some women a feeling of youthful wellbeing. The disadvantages of HRT are that there may be an increased risk of cancer of the womb. This is only if oestrogen is given alone, rather than with progesterone or a similar hormone. HRT increases to a minor degree the risk of benign and malignant breast lumps. This risk increases the longer a woman take HRT and mainly affects women who are on HRT for more than 5 years. Women who have a family history of breast cancer can take HRT. During the first 6 months of treatment there is an increase in the risk of deep vein thrombosis (blood clots in the veins in the leg that may also affect the lung) but the overall risk is very small. Most, but not all, doctors believe the advantages outweigh the disadvantages. If treatment is to be undertaken the blood pressure should be recorded. The breasts should be examined and an x-ray of the breasts (mammography) may be done. An internal examination and a smear test is also done. Following hysterectomy, oestrogen may be given alone. Otherwise a combination of oestrogen and progesterone is used. Some tablets combine the two hormones. These are taken daily, with or without getting a period. You may have an oestrogen implant. A pellet of oestrogen is inserted under the skin of the abdomen or thigh under local anaesthetic. It releases hormone for 6 to 9 months. If the womb has not been removed, progesterone tablets are given for 7 to 10 days each month. You may use a patch . This is like a sticking plaster which contains oestrogen which is absorbed through the skin. Again, you may need to take progesterone. The patches are replaced twice a week. Progesterone may also be taken as a patch. Every woman on HRT should be checked after 3 months. If all is well and she is happy, she should be checked at least every year. The blood pressure, breasts and internal pelvic organs will also need to be checked. It is important that each woman discusses the advantages and disadvantages of HRT with her doctor before starting treatment. These will be different for each woman depending on her medical history and age.

During Treatment with Hormone Replacement Therapy (HRT)

If being treated for symptoms, there should be an improvement within 2 or 3 weeks and certainly by 3 months. If symptoms are not helped in 3 months then longer-term treatment may not be necessary. Possible complications include headaches or migraine, a rise of blood pressure, and some weight gain. If periods have previously stopped, they may start again.

After Treatment with Hormone Replacement Therapy (HRT)

It is not known how long a woman should continue treatment. Many women continue HRT into their 60s and beyond. As long as you have a regular check-up and are happy, it probably does not matter. HRT is not a contraceptive but even if started before the menopause, you would be very unlikely to conceive.

If Left Untreated

The normal menopause does not have to be treated. The greatest likely benefit of HRT is to reduce the risk of fractures in the elderly, and possibly reduce the risk of heart attack and stroke in later life. If the menopause occurs early, either naturally or as a result of medical treatment the lifetime risks of heart disease and fractures from osteoporosis are definitely greater. HRT will usually be recommended until the age of 50, but occasionally longer.