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Get ready to discover everything you need to know about Hormone Replacement Therapy (HRT) in Perimenopause and Menopause.
With this guide, you’ll understand how HRT works to relieve menopause symptoms, discover its benefits beyond just managing hot flushes (hot flashes) and rock your journey through menopause with confidence.
When it comes to HRT, many people think it's only about alleviating menopause symptoms but the truth is HRT can also support your long-term health.
If you're a longtime advocate for women's health and you’re beyond the how, what, and why of HRT, this could be a great refresher for you. Do check out my blog page for deep-dives on all things menopause.
Table of Contents
HRT Explained
If you've ever thought “HRT...what exactly does it do?"…then you're in the right place.
Understanding HRT is the first step to rocking a fully informed and empowered menopause journey.
HRT stands for Hormone Replacement Therapy.
Hormone replacement therapy (HRT) is the first-line treatment to improve menopause symptoms of the perimenopause and menopause by topping up or replacing your missing hormones.
All types of HRT will usually contain oestrogen, progesterone (if you still have a uterus) and sometimes testosterone.
The safest and most regulated type of HRT – and that prescribed by the NHS – is body identical HRT. This is derived from the yam plant and has the same molecular structure as the hormones you produce naturally from your ovaries.
Many private clinics use 'bioidentical’ hormones. They are neither licensed nor regulated and are not recommended.
HRT helps manage the symptoms associated with low hormones like hot flushes (hot flashes), mood swings, anxiety and more...but also it has benefits for your future health. It means a lower future risk of developing conditions including heart disease, osteoporosis, diabetes, depression and dementia.
If you’ve been in the menopause world for a while, you might already be familiar with the various delivery methods—tablets, patches, gels, or sprays—and how they work differently to suit individual needs. If not, we’ll be covering this a little later.
HRT is all about relieving menopause symptoms and improving your future health...but it isn’t your only option.
If you want to know more about Menopause without HRT, give the post below a read.
Related Post: Menopause without HRT - Everything you Need to Know
HRT Facts and Statistics
Let's look at the science of HRT. Here are some facts and statistics from leading menopause specialists:
If you’re a total nerd for the science of menopause health and ageing, including HRT, then I highly recommend Liz Earle’s book ‘A Better Second Half’.
Liz shows us how to future-proof our health in midlife and beyond using evidence-based techniques, ideas and wisdom accumulated over her years of experience in the wellbeing arena.
The Impact of Misinformation on HRT
A study and the reporting of it in 2002 (called the Womens Health Initiative (WHI) Study) are responsible for making many women scared and worried about taking HRT.
However, the findings have since been shown to be flawed. It studied women who are older (in their 60s) and they were given a type of HRT that isn’t prescribed now. The authors of the study have since apologised in a medical journal (NEJM) and admitted that people misinterpreting the results of their study was the reason that women are unnecessarily worried about taking HRT.
HRT still unfortunately has a negative press, even today.
What you need to know about HRT
Hormone Replacement Therapy (HRT) is such a vast field of numerous approaches, benefits and risks. It’s easy to get lost in the overwhelming amount of information available, so how do you figure out how to get started?
Grab a cup of herbal tea and a notebook, and let’s dive in.
1. First, don’t be scared of HRT
Do you still believe HRT is dangerous?
It’s not your fault. Many women are afraid of hormone replacement therapy (HRT) due to concerns about breast cancer, blood clot, heart disease and cardiovascular disease.
However, according to the Menopause Charity, much of this fear is not based on evidence and there has been inaccurate reporting about the risk of breast cancer.
Step 1. Know the up-to-date facts
Dr Louise Newson, on her Balance Menopause website, explains about HRT and breast cancer.
Women with a family history of breast cancer should discuss it with their doctor if they are considering HRT. A woman’s lifetime risk of getting breast cancer is 1 in 7. This means that 1 in 7 women taking HRT will get breast cancer – not because of the HRT, but because they would have developed it anyway.
There is no strong evidence that having a family history of breast cancer puts you at any higher risk of getting breast cancer if you take HRT, compared to women who do not have a family history of breast cancer. There is some evidence that women with a family history of breast cancer who take HRT actually have a lower future risk of developing breast cancer compared to women not taking HRT.
This means that women with a family history of breast cancer, including those women with a BRCA gene, can still usually take HRT safely. As there are many health benefits of taking HRT, women can usually take HRT forever, they do not have to stop taking it at a certain age or after a specific length of time.
What is of course needed in these situations is individualised care.
Step 2. Seek out the many positive stories about HRT
My own menopause journey was a rollercoaster and HRT has been a very positive experience for me.
Here is my own story so far
Step 3: Read my blog
There are a LOT of myths surrounding the menopause. Have a read of this blog post to find out more:
Related Post: 5 Menopause Myths that every woman needs to know
So if you want to consider all the treatment options available to you during the perimenopause and menopause, you need to know that HRT is safe and effective. Understanding that will help you make up for lost time and push forward with your menopause health goals.
2. Know all your HRT options
This video from Dr Louise Newson is really useful for learning all about oestrogen, progesterone and testosterone HRT and how to get the right dose and type for you.
Specific vaginal oestrogen can be prescribed for ‘Vaginal Atrophy’, more commonly known as vaginal dryness and whose official worldwide term is GSM (genitourinary syndrome of menopause). These are menopause symptoms that can affect the whole urogenital area; inside of the vagina, the vulva (external), bladder, urethra and the whole pelvic floor area.
GSM varies from mild to severe and includes dryness, discharge, burning, soreness, itching, urinary tract infections, painful sex and smear tests, bleeding, urinary incontinence and thinning skin.
There are non-hormonal or hormonal products available – often a combination of both works best. Oestrogen products available are pessaries, creams and rings, all of which are available on the NHS. There is also a huge choice of vaginal moisturisers.
3. Educate Yourself
It’s essential to educate yourself by gaining a solid understanding of the different stages of the perimenopause and menopause and the different treatments available, including HRT.
Knowledge is POWER. Being informed about physical and emotional changes, symptoms, treatment options and the resources available will give you much needed confidence.
Without this, you're in danger of being dismissed by people who may not have a full understanding of the menopause, resulting in ineffective treatment and your prolonged suffering.
4. Follow the Menopause Experts
If you’re serious about your menopause health then it’s a good idea to follow the work of Menopause specialists who will answer all your menopause-related questions.
Some of the experts and specialists I recommend are:
Nutritionist Emma Bardwell
Nutritionist Karen Newby
Dr Newson is passionate about increasing awareness and knowledge of the perimenopause and menopause, and campaigns for better menopause care for all people.
She has an abundance of information on her Balance Menopause website and app on HRT and breast cancer.
5. You Can Maximize Your Results with Simple Lifestyle Changes
Did you think you had to have complex treatment plans to get results?
That’s one way, but did you know that you can also get powerful results by combining HRT with simple lifestyle changes like diet, exercise, and stress management?
First Simple Thing: Incorporate a balanced diet rich in protein, phytoestrogens and fibre.
Second Simple Thing: Regular physical activity to boost mood and manage weight.
Third Simple Thing: Stress reduction techniques like yoga or mindfulness meditation.
6. Regular Check-Ups and Adjustments
I’ve lost count of the number of times I’ve heard women say “I’m on HRT but I still feel awful”
Many women need their HRT dose or type altered over time.
When you start HRT for the first time, there may be a noticeable improvement initially but then not as much as you were hoping for, or there may be a return of some symptoms.
You might need a higher dose, a different type or to add in testosterone.
Make sure that you keep in regular contact with your doctor to discuss your ongoing treatment plan.
Frequently Asked Questions
What is the downside of HRT for menopause?
The British Menopause Society advises that, although there have been concerns raised about HRT and the potential risks to various aspects of women’s health, more recently published findings show that although not entirely risk free, it remains the most effective solution for the relief of menopausal symptoms and is also effective for the prevention of osteoporosis. It may in certain age groups provide protection against heart disease.
It’s important to consult with a healthcare provider to weigh the benefits and risks based on your individual health profile and needs.
What does HRT do for menopause?
HRT helps to reduce the symptoms of menopause by replacing hormones, primarily oestrogen, progesterone and sometimes testosterone, that the body stops producing in sufficient amounts during menopause. It can reduce symptoms such as hot flashes, night sweats, mood changes and vaginal dryness. There are long term benefits too. HRT aims to make the transition through menopause smoother by managing hormonal imbalances.
Is it better to go through menopause without HRT?
Whether or not to use HRT is a personal decision. Some women choose to go through menopause without HRT, opting for lifestyle changes and alternative therapies to manage symptoms. Others find that the benefits of HRT, such as relief from severe symptoms, outweigh the risks. It’s not a one-size-fits-all solution, so it’s important to consider factors like overall health, symptom severity and personal preferences.
What happens to a woman's body when oestrogen is low?
When oestrogen levels decline during menopause, women may experience symptoms such as hot flashes, night sweats, mood swings, vaginal dryness and reduced bone density. Low oestrogen can also contribute to an increased risk of cardiovascular disease and osteoporosis, making it essential to monitor and address these changes.
Why does HRT have a bad reputation?
HRT developed a bad reputation after early studies, particularly the Women's Health Initiative (WHI) in 2002, suggested increased risks of breast cancer, stroke and heart disease. However, newer studies have shown that for many women, the benefits of HRT often outweigh the risks. Public perceptions are shifting, but the lingering concerns from earlier research still influence views on HRT.
What are the signs that you need HRT?
Signs that you might benefit from HRT include severe menopausal symptoms like frequent hot flashes, night sweats, mood swings, sleep disturbances and vaginal dryness that significantly affect your quality of life. Speaking with a healthcare provider can help you decide if HRT is the right option for managing your symptoms.
Jumpstart your Menopause Health Journey
Now you know exactly what HRT is all about.
As a thank you for making it to the end of this blog, I created a FREE Menopause Health Guide you can use to make a start on improving your menopause health.
Want to know more?
Jane offers affordable one-to-one menopause health sessions or a 12-week online programme.
She is an affiliate member of The British Menopause Society and a member of The International Practitioners of Holistic Medicine.
Find out more about Jane’s services at www.janemackaycoaching.com or contact Jane directly at jane@janemackaycoaching.com
DISCLAIMER: This page does not provide medical advice; it is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek professional medical advice on any of the topics covered on this page.
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