HRT has many benefits to menopausal women, although with long term use it can have some serious side effects too.
These side effects have received a lot of publicity recently, and led to a reappraisal by the medical establishment on how HRT is administered, and to whom. In the UK, the recommendation now is to prescribe HRT to women who experience severe side effects during menopause. But when women do not suffer side effects, the feeling is that the risks outweigh any possible benefits. But given that up to 75% of women in the UK have severe menopausal symptoms, this still leads to widespread use.
Doctors in the UK have said that in the short term, the risks of HRT are minimal. But the longer a woman takes hormone replacement therapy, the greater is the risk of developing breast cancer and strokes.
HRT comes in different forms. There is estrogen-only HRT, which tends to be given only to women who don’t have their uterus as it can increase the risk of developing endometrial cancer. This is because all of that estrogen causes the endometrial lining of the uterus to build up. The other types of HRT also contain estrogen, as the goal of hormone replacement therapy is to replace the estrogen that the body is producing less of. But they have a type of progesterone called progestogen added to them. Progestogen is an oral form of progesterone that counteracts the build up of uterine tissue. It is stronger than progesterone cream, which does not counteract the effects of estrogen on the uterus.
Hormone replacement therapy can be taken orally, as a patch, a cream, gels, nasal sprays, implants, a pessary, or as a vaginal ring that contains estrogen. The latter will help reduce vaginal symptoms.
It’s important to remember that HRT is not a contraceptive. So, if you are still menstruating when you start taking hormone replacement therapy, you’ll still need to use some form of birth control. The form of HRT given to women who are still menstruating is a sequential combined HRT. Estrogen is taken every day, but progestogen is also taken for 12 to 14 days of a woman’s cycle. Thus, women will still bleed every month. It should only be light however. And as HRT doesn’t cause ovulation or restore fertility, these will not be like regular periods. However, if your body is still ovulating naturally, however irregularly, there is a risk of falling pregnant even whilst taking hormone replacement therapy. Whilst the chance of falling pregnant is lower, as many as two thirds of the women between the ages of 40 and 44 are still ovulating regularly. So, it’s important to consider some form of contraception if you don’t want to fall pregnant.