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Your complete guide to HRT for menopause

In this guide, we'll take you through the most important things you need to know about hormone replacement therapy (HRT).

What is HRT?

HRT stands for Hormone Replacement Therapy and is used to treat menopause symptoms.

Lots of perimenopause and menopause symptoms (like night sweats, hot flushes and brain fog) are caused by the sudden decreases in a hormone called oestrogen that happens when someone reaches menopausal age.

HRT increases the amount of oestrogen in the body which then can be impactful in reducing these symptoms. You can find our guide to menopause here.
How does HRT work?

There are different types of HRT that you can take. How long HRT takes to work and how long it stays in your system depends on the type of HRT you use, as well as which symptoms of menopause you're experiencing.

Finding the right type of HRT can be difficult, so we've summarised the different types of HRT you can take, so you can make an informed choice about which might work best for you and your lifestyle.

- Skin patches: These get stuck on your body and slowly release oestrogen. They usually have to be replaced every few days
- Gels: Oestrogen gel is rubbed onto your skin once a day and absorbed into the body to increase oestrogen levels in the blood
- Implants: These are small pellets that are inserted below your skin by a doctor and slowly release hormones over several months
- Tablets: Tablets are the most common form of HRT. They need to be taken orally once a day.
- Vaginal oestrogens: Such as creams, tablets or rings that are used to treat vaginal symptoms of menopause and perimenopause like dryness, itching and pain during sex

Find out more about:
A guide to the different types of HRT
How Hormone Replacement Therapy works

How do you get HRT?

You'll need a prescription to access nearly all types of HRT medication. You should be able to a prescription from you GP, or you could speak a menopause specialist, like one of our British Menopause Society certified Fertifa Doctors.

It's always best to speak with your doctor or another menopause healthcare professional about the symptoms you are experiencing, to help work out which type of medication would be best for your personal circumstances. Usually, you can start HRT as soon as you start experiencing menopause symptoms, but if you are under 45 your doctor might suggest doing a blood test first to be sure it's the right option for you.

In 2020, the first over the counter HRT was made available in the UK, called Gina 10. Gina 10 is a low does oestrogen tablet that are inserted to the vagina, to target vaginal menopause symptoms like dryness, itching and painful intercourse.

If you're a Fertifa patient looking to understand more about HRT, get in touch via the app. Our doctors and nurses can talk you through HRT and give you a prescription if they agree it's suitable for your menopause symptoms.

What are the benefits of HRT?

There are a wide range of symptoms that can affect peri-menopausal women, and whilst 75% of women do experience difficult or worrying symptoms, this does mean that 25% probably won't have any symptoms that impact their day-to-day life.

Usually, a doctor will prescribe HRT to treat symptoms of the menopause or to prevent long term health conditions. If you are menopausal, or around the age of menopause, but don't fall into either of these categories you may not need to take HRT.

If you do need hormone therapy, one of the main benefits is that it relieves most perimenopause and menopause symptoms, including:
- Hot flushes and night sweats
- Brain fog
- Vaginal symptoms like dryness or itching
- Reduced sex drive
- Bladder problems

Find out more about:
The menopause symptoms and what to expect
A guide to menopause
How to manage and treat hot flushes

What are the risks of starting HRT?

HRT can be a great option for those who suffer from menopausal symptoms who want to improve their quality of life or want to reduce their risk of developing long-term health conditions, particularly when it comes to bone health and heart health.

However, it’s important to understand the potential risks so you can make an informed decision about whether HRT is right for you.

The risks of HRT will depend the type of hormone therapy you are taking, on your own medical history and family history. HRT can increase the risk of breast cancer, the risk of ovarian cancer, in some people the risk of endometrial cancer (also called womb cancer). Some types of HRT can also increase the risk of stroke and the risk of blood clots or venous thromboembolism.

In most people, scientific evidence shows that the increase in risk is very minimal, so the benefits of HRT are much greater than the risks. HRT can also come with various side effects you should be aware of, such as vaginal bleeding, breast tenderness and leg cramps. You should speak with your doctor about your medical history and family history if you have any concerns about whether HRT is right for you. If genetically you have higher risks of breast cancer, for example, a health professional may advise against HRT.

Read our guide on how to know if you need HRT here

What are the other ways to treat menopause symptoms?

There are lots of alternative treatment options to Hormone Replacement Therapy and these can also be used in conjunction with HRT too.

These complimentary therapies include lifestyle changes like maintaining a healthy weight and natural remedies such as acupuncture or herbal treatments. Diet is another important factor in managing menopause symptoms. Dietary supplements such as black cohosh and avoiding potential triggers, like spicy food and alcohol, are a good first step in managing menopausal symptoms without hormone treatment too.

Other complementary therapies include looking after your mental health with talking therapies, cognitive behavioural therapy, mindfulness and keeping fit with regular exercise.

Weight bearing exercise is important for bone strength. By minimising the weakening of bones and stabilising emotions, vitamin D supplements also help relieve symptoms caused by declining oestrogen levels. If you are particularly suffering from urinary incontinence and/or pain during sex, practicing Kegel exercises will help strengthen your pelvic floor muscles and can help tackle these symptoms.

According to NHS guidance and the guidance of our in-house clinical team (led by Dr. Gidon Lieberman), the risks of HRT are minimal, with little to no increase in the probability of developing breast cancer, blood clots or heart disease following hormone therapy.

Find out more about:
Our guide to complimentary and alternative menopause therapies
A guide to menopause