Hormone Replacement Therapy (HRT) is the most effective way to treat symptoms of the perimenopause and menopause. This is a treatment that replaces the female hormones that are fluctuating or falling. You might not realise that you can still have symptoms (and can take HRT) even if you’re still having regular periods. In fact, HRT is most effective when you start taking it before (or within 10 years of) reaching the menopause.
HRT works to tackle the underlying cause of your symptoms: low levels of female hormones. It can effectively treat common symptoms including hot flushes, night sweats and low mood, as well as many other, less well-known menopause symptoms. As an added bonus, it also helps to protect your bones and can reduce your risk of cardiovascular disease, including heart attack and stroke, type 2 diabetes, clinical depression and dementia.
Several years ago, media reports linked HRT to an increased risk of breast cancer and blood clots. These studies have since been shown to be flawed, and more up-to-date research indicates that, for most women, the benefits of HRT outweigh any risks.
The hormones in HRT
HRT is a treatment that includes oestrogen, progesterone and, in some cases, testosterone. Depending on your health and individual medical history, you may need one or two of these hormones, or a combination of all three.
You might have heard that HRT is made from horse urine, which it was in the past. These days the type of oestrogen used is typically 17 beta-estradiol, which is made from yams. Although it’s derived from a root vegetable, this has the same structure as the oestrogen that you made in your body.
If you still have a womb, you’ll also need to take progesterone. This is important because taking oestrogen on its own can thicken the lining of the womb and increase the risk of uterine cancer. Taking progesterone keeps the lining thin and reverses this risk.
When you take both oestrogen and progesterone, this is known as combined HRT. The safest type of progesterone is called micronised progesterone (in the UK this is branded as Utrogestan), which is also made from yams. Alternatively, you can opt to have a coil inserted, which releases progesterone directly into your uterus, and also works as a form of contraception.
If you still suffer symptoms like fatigue, brain fog and low libido after taking HRT for several months, you might also benefit from testosterone. Your ovaries produce most of the testosterone in your body, so if you’ve had them surgically removed, then your testosterone levels will drop very quickly. In the UK, testosterone isn’t currently licensed as a treatment for menopausal symptoms, but it’s widely (and safely) prescribed by menopause specialists and some GPs.