Hormone Replacement Therapy (HRT) : Type, Side Effects & Treatment

Many people looking for relief from menopausal symptoms consider going for hormone replacement therapy (HRT). Knowing the benefits, side effects and risks of HRT can help you decide whether it’s beneficial for you or not. In this article, we will learn what is HRT, its types, benefits, side effects and much more.

What is hormone replacement therapy?

During menopause, the estrogen levels of women fall and they might experience unpleasant symptoms like hot flashes and vaginal dryness. HRT also known as hormone replacement therapy can help relieve these menopausal symptoms. HRT replaces hormones that are at a lower level as one approaches menopause.

Benefits of hormone replacement therapy

HRT can provide the following benefits:

• Relieve hot flashes and night sweats

• Reduce mood swings and irritability

• Ease vaginal dryness and itchiness

• Help fix reduced sex drive and painful sex

• Prevent fractures caused by osteoporosis

• Lower chances of dementia and heart diseases

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Types of HRT

There are many types of HRT and finding the right one can be difficult.

1. HRT hormones

Most women take a combination of estrogen and progesterone hormones, although women without a uterus can even take estrogen alone.

2. Ways of taking HRT

HRT treatment is available in different ways such as tablets, skin patches, gels, vaginal creams, pessaries or rings.

3. HRT treatment plans

HRT medicine can be taken in cycles where estrogen is taken without stopping but progesterone only every few weeks or without stopping.

A doctor can help you decide which might be the best HRT treatment for you. It’s possible you may need to try more than one type of HRT to find which works best for you.

Risks of HRT

Although the benefits of hormone replacement therapy outweigh the risks, you must know the risks of HRT. HRT can increase your risk of:

• Endometrial cancer, if you take estrogen and progesterone while you still have a uterus

• Blood clots

• Stroke

• Breast cancer

Side effects of HRT

As with any medicine or treatment, HRT can cause certain side effects. But these side effects tend to pass within 3 months of starting treatment.

Some common side effects of HRT include:

• Breast tenderness

• Headaches

• Feeling sick

• Abdominal pain

• Indigestion

• Vaginal bleeding

Who should avoid Hormone Replacement Therapy?

Although most women can have HRT if they are experiencing menopausal symptoms but HRT may not be suitable for some women.

You should avoid HRT if you:

• Are pregnant

• Have a history of blood clots

• Have untreated high blood pressure

• Have liver disease

• Have a history of breast cancer, ovarian cancer or uterine cancer

You may be recommended alternatives to HRT under such circumstances.

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How to begin HRT?

If you are interested in starting hormone replacement therapy, you should first consult a doctor.

• Most women can begin HRT as soon as they first experience menopausal symptoms without having any tests before.

• A doctor can explain to you the different types of HRT in order to help you choose the most suitable one for you.

• Most women start with a low dose, which can be increased at a later stage. The treatment can take a few weeks to be effective and cause some side effects initially.

• The doctor will recommend you switch to a different treatment or change the dose to see if it helps.

How to stop HRT?

Although there is no limit on how long one can take HRT, you should follow the recommendations of your doctor.

• Most women stop taking HRT once they find relief in their menopausal symptoms, which usually takes a few years.

• Women who take HRT for over a year have an increased risk of breast cancer than women who never try HRT.

• This increased risk of breast cancer comes down after you stop HRT but some risk remains for over 10 years compared to women who never tried HRT.

• You can either stop HRT gradually or suddenly but it is recommended to gradually stop taking HRT so that the symptoms don’t come back soon after.

Alternatives to hormone replacement therapy

If you cannot take HRT, you may want to consider some alternatives to hormone replacement therapy to control your menopausal symptoms such as:

1. Lifestyle changes

Lifestyle changes like exercising regularly, consuming a healthy diet, cutting down on caffeine, alcohol and spicy foods and quitting smoking can help relieve some of your menopausal symptoms.

2. Tibolone

Tibolone is a medication similar to HRT (estrogen and progesterone combined) but it is only suitable for women who had their last period over a year ago.

3. Clonidine

Clonidine is a non-hormonal medication that may relieve hot flushes and night sweats in some women but the benefits are limited.

4. Antidepressants

Some antidepressants can help relieve hot flushes and night sweats but it can cause some unpleasant side effects like dizziness and agitation.

Whatever is your choice- HRT or its alternatives, it’s important that you consult your doctor and discuss the pros and cons of the treatment.

References

1. Harper-Harrison G, Shanahan MM. (2023). Hormone Replacement Therapy.