Hormone Replacement Therapy
NHS Direct Online Health Encyclopaedia
Hormone replacement therapy (HRT) is the artificial replacement of the female hormone oestrogen in women who are going through the menopause.
During the years between puberty and the menopause, womens ovaries make a hormone called oestrogen. Oestrogen has many functions. The main one is to stimulate development of the female sexual characteristics: breasts, pubic hair and body shape, and development of the genitals and womb.
The menopause in women normally happens around the age of 50, when the ovaries, which produce reproductive hormones, shut down either suddenly or gradually. This has many effects. The risk of heart disease and stroke increases after the menopause, and the 3% to 5% loss in bone mass every year due to lack of oestrogen can lead to brittle bones and osteoporosis.
Periods become irregular and stop, and many women develop hot flushes and night sweats, with mood swings and depression. Loss of sex drive and vaginal dryness are common, which can lead to relationship difficulties.
HRT can help to reduce the symptoms of the menopause, but it can also have serious side effects. You should discuss the risks and benefits fully with your doctor before making a decision on whether to take HRT.
Hormone replacement therapy (HRT) has become the standard treatment for relieving the symptoms associated with the menopause. Most women take a combination of oestrogen and progestogen (a synthetic form of the hormone progesterone), although oestrogen-only and progestogen-only forms of HRT are also available.
The progestogen is added to protect against cancer of the womb (uterus), as there is an increased risk of the condition with oestrogen-only HRT. However, oestrogen alone may be prescribed to women who have had a hysterectomy (surgical removal of the womb).
When should it be done?
HRT should be started when the menopause starts. In most women, this is around the age of 50. Symptoms such as hot flushes and night sweats are usually the first to improve (often within the first two weeks of starting HRT), and other symptoms should improve thereafter. As so many treatment options are available, it may be necessary to try different types of HRT before finding the most suitable preparation.
HRT should not be taken by a woman who:
Has had breast or womb cancer, as dormant traces of the disease could theoretically be stimulated by HRT
Has unusual vaginal bleeding that hasn't been investigated
Has severe liver disease
Has had a stroke or deep-vein thrombosis, or has untreated high blood pressure
May be pregnant (still the most common reason for periods to stop, and a possibility for up to two years after the start of the menopause).
The treatment options available should be carefully discussed with your doctor if you suffer from migraine, or from conditions such as insulin-dependent diabetes or irritable bowel syndrome which may have an impact on the method of HRT delivery (e.g. patches rather than tablets).
You should also discuss the options with your doctor if you have a family history of breast cancer.
HRT can improve quality of life during the menopause for women experiencing severe symptoms. For women whose quality of life is not affected by menopausal symptoms, the Royal College of Obstetricians and Gynaecologists suggest that the risks of taking HRT outweigh the benefits. The longer women take HRT, the greater the risks of breast cancer and strokes.
The worst of the menopausal symptoms should be over within one to two years, although some women choose to continue taking HRT for longer, following discussion with their doctor.
How to stop the treatment depends on the length of the course:
less than 5 years - the HRT can usually be stopped at the end of a current pack
more than 5 years - reduce the dose gradually.
© Queen's Printer and Controller of HMSO, 2005
Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland.
Recent publicity concerning the health risks of synthetic hormone replacement therapy has led many women to seek more natural solutions. And with good reason. In areas of the world where soy and other estrogenic plants are part of the diet, breast cancer rates are much lower and menopausal symptoms are almost non-existent. Synthetic hormone replacement is not common because it is not needed.
In the U.S., where pharmaceutical companies make $8 billion a year on synthetic hormones, breast cancer, heart attacks and strokes are increasing dramatically among menopausal women. Dr. John Lee, author of "What your Doctor May Not Tell You about Menopause", blames the increases on synthetic hormones. He says that the pharmaceutical companies are well aware of the problems. "The whole thing is madness," he says, "and it's driven by greed." A few simple and natural solutions can clear up the menopausal problems and eliminate the health risks associated with the synthetic hormones.
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