This leaflet sets out the known facts about HRT. It summarises the results of studies regarding its safety and addresses the controversy that still surrounds it, together with current thinking about its suitability. It is written specifically for women wishing to know about HRT.
Our medical advisory panel strongly recommends that you should discuss with your doctor both the benefits and the risks of HRT on an individual basis. The types of HRT available are listed below. HRT was first available in the s but became more widely used in the s, creating a revolution in the management of the menopause. HRT was prescribed commonly to menopausal women for the relief of their symptoms such as hot flushes, night sweats, sleep disturbances, psychological and genito-urinary problems — urinary frequency and vaginal dryness — and for the prevention of osteoporosis.
The published results of these two studies during and raised concerns regarding the safety of HRT. These safety concerns revolved around two main issues: 1 that the extended use of HRT may increase the risk of breast cancer and 2 that the use of HRT may increase the risk of heart disease. The results of the studies received wide publicity, creating panic amongst some users and new guidance for doctors on prescribing. After the results were published, the UK regulatory authorities issued an urgent safety restriction about HRT, recommending that doctors should prescribe the lowest effective dose for symptom relief, should use it only as a second line treatment for the prevention of osteoporosis, and advised against its use in asymptomatic postmenopausal women.
There remains widespread confusion and uncertainty amongst both doctors and HRT users. Many doctors stopped prescribing HRT and many women abandoned HRT immediately, with a return of their menopausal symptoms. HRT needs to be prescribed for each woman individually.
Some women experience side effects during the early stages of treatment, depending on the type and dose of HRT. These side effects will usually settle within the first few months of treatment and may include:. These small risks must be balanced against the benefits of HRT for the individual woman. Talk to your doctor about any concerns you may have. Women over 50 years of age who use combined oestrogen and progestogen progesterone replacement for less than five years have little or no increased risk of breast cancer.
Women who use combined HRT for more than five years have a slightly increased risk. Women on oestrogen alone have no increased risk up to 15 years of usage. There is no evidence to suggest that a woman with a family history of breast cancer will have an added increased risk of developing breast cancer if she uses HRT. The risk with combined oestrogen and progestogen is greater than with oestrogen alone, or with newer HRT agents such as tibolone sold as Livial or Xyvion , and may also depend on the type of progestogen used.
Studies suggest that medroxyprogesterone acetate and norethisterone have higher risks than dydrogesterone and progesterone. Women over 60 have a small increased risk of developing heart disease or stroke on combined oral tablet HRT. Although the increase in risk is small, it needs to be considered when starting HRT, as the risk occurs early in treatment and persists with time. Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch.
Similarly, tibolone increases the risk of stroke in women from their mids. Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more. Venous thromboses are blood clots that form inside veins. Women under 50 years of age, and women aged 50 to 60, face an increased risk of venous thrombosis if they take oral HRT.
The increase in risk seems to be highest in the first year or two of therapy and in women who already have a high risk of blood clots. This especially applies to women who have a genetic predisposition to developing thrombosis, who would normally not be advised to use HRT.
Limited research to date suggests the increased risk of clots is mainly related to combined oestrogen and progestogen in oral tablet form, and also depends on the type of progestogen used.
Some studies suggest a lower risk with non-oral therapy patches, implants or gels or tibolone. The endometrium is the lining of the uterus. Use of oestrogen-only HRT increases the risk of endometrial cancer, but this risk is not seen with combined continuous oestrogen and progestogen treatment. There is no risk if a woman has had her uterus removed hysterectomy. It replaces hormones that are at a lower level as you approach the menopause. The main benefit of HRT is that it can help relieve most of the menopausal symptoms , such as:.
Many of these symptoms pass after a few years, but they can be unpleasant and taking HRT can offer relief for many women. It can also help prevent weakening of the bones osteoporosis , which is more common after the menopause. The benefits of HRT are generally believed to outweigh the risks. Read more about the risks of HRT. You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first.
A GP can explain the different types of HRT available and help you choose one that's suitable for you. You'll usually start with a low dose, which may be increased at a later stage. For some women, the symptoms are mild, and they go away on their own. Other women take hormone replacement therapy HRT , also called menopausal hormone therapy, to relieve these symptoms. HRT may also protect against osteoporosis. There are different types of HRT. Some have only one hormone, while others have two.
Most are pills that you take every day, but there are also skin patches, vaginal creams, gels, and rings. Taking HRT has some risks. For some women, hormone therapy may increase their chances of getting blood clots , heart attacks , strokes , breast cancer , and gallbladder disease. Certain types of HRT have a higher risk, and each woman's own risks can vary, depending upon her medical history and lifestyle.
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