HRT treatment – how does it work?

You have probably heard the phrases HRT, HRT treatment and hormone replacement therapy – the full name for HRT. All are used to describe the replacement of natural hormone levels in women during and after the menopause. Some women find that they never need HRT treatment, even though some of the symptoms of the menopause can be uncomfortable at times. Others experience such improvement in their quality of life with HRT that they cannot bear to think of living without it.

This article on HRT / hormone replacement therapy treatment is by Kathryn Senior, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

Why might women need HRT treatment?

With age, women’s bodies produce less of the female hormone oestrogen, which drives ovulation and the menstrual cycle. Once oestrogen production drops below a certain level, the menstrual cycle stops. The phase of life that leads up to and follows a woman’s last monthly period is called the menopause. The early and later stages can also be described as the peri-menopause.

Not all women experience symptoms during the menopause and some may notice only mild changes that do not cause them any concern. Other women experience unpleasant menopausal symptoms that they find difficult to tolerate. Because these symptoms are a result of falling hormone levels, they can often be relieved with HRT treatment, which replaces the lost hormones.

What symptoms prompt women to seek the treatment?

The range of symptoms that prompt women to seek HRT treatment can include hot flushes, fatigue, irritability/mood swings, depression, anxiety, palpitations, sleep disturbance and loss of interest in sex. Physical symptoms can also occur, including changes to the vulva and/or vagina such as vaginal dryness, which can make sex less comfortable and sometimes painful. Similar symptoms may be experienced by women who have had a hysterectomy, or those experiencing premature menopause.

Some women find the combination and duration of these unpleasant symptoms affects their whole attitude to life. They lack energy and can even start to feel depressed. HRT treatment offers a way to reduce their symptoms and give them a renewed energy at the start of their middle age.

What is HRT treatment?

Hormone replacement therapy treatment works by replacing the oestrogen that the body no longer produces after a certain point in the menopause. This can reverse many of the changes that naturally occur with the ‘change of life’.

HRT treatment is generally effective at relieving the physical symptoms of menopause such as hot flushes and vaginal dryness. It can also help with many of the psychological symptoms associated with menopause that are due to declining hormone levels. However, if you are experiencing symptoms connected with the emotional impact of reaching menopause, or due to other aspects of your home or work life, these issues are unlikely to be resolved with HRT treatment alone.

What types of treatment are available?

There are two main types of HRT treatment:

1. oestrogen-only HRT treatment
2. HRT treatment, which contains both oestrogen and progesterone
Women who have not had a hysterectomy are typically given combined HRT treatment so that progesterone can balance the effects of oestrogen on the uterus.

HRT treatment is most often taken as a daily tablet but it can also be administered through the skin via patches or topical gels, or using an implant placed under the skin. Alternatively, a pessary or cream can be used vaginally, although this only acts locally to reduce vaginal symptoms and will not relieve other symptoms. A ring that releases HRT treatment slowly over time can be placed into the vagina every 3 months, or a nasal spray can be used.

A synthetic steroid known as tibolone is sometimes used as an alternative to HRT treatment and can be more effective than natural HRT. However, it is not suitable for everyone. Your doctor will advise you whether synthetic or natural HRT treatment is best for you.

Will I start having periods again if I take the treatment?

It depends on the type of HRT you are prescribed. In women who are approaching menopause but are still experiencing some natural periods, sequential HRT treatments are often used that mimic the natural hormone cycle. These result in monthly bleeds, much like the contraceptive pill.

Other sequential treatments are available that produce bleeds every 3 months and these are often used in women who are still having a few, infrequent natural periods. However, if you have not had periods for a year or more (i.e. you are postmenopausal), your doctor is likely to prescribe ‘period-free’ or ‘continuous’ HRT treatment, which is designed not to lead to regular bleeds. While some bleeding may occur initially with this type of HRT, this usually stops within around 6 months of starting treatment.

Are there any risks associated with the treatment?

Many women experience no side effects with HRT treatment, but others report nausea, breast tenderness, water retention and weight gain. Minor side effects such as these often settle down within a few weeks or months of beginning HRT treatment.

HRT has been associated with small increases in the risk of developing breast, endometrial or ovarian cancers, as well as thrombosis (a blood clot in the vein) and cardiovascular disorders such as stroke or heart attack. A possible association with dementia has also been suggested.

To reduce the risks associated with HRT treatment, it is generally only prescribed for 1–3 years to ease symptoms during the menopausal period. However, women experiencing early menopause may be prescribed hormone replacement therapy treatment for longer to help prevent osteoporosis, which can follow premature loss of hormone production.