Hormone Replacement Therapy (HRT)

Peri-menopause

This stage is usually around 3 to 5 years before menopause and is where your progesterone and oestrogen levels begin to drop. You may get irregular periods and other common symptoms. Every woman is different and some may get more symptoms than others. You may still get pregnant during this time, as you have not yet entered menopause.

Menopause

The menopause is when you have your last period. The average age this happens in the UK is 51, but most women will reach this between the ages of 45 and 55.

Post-menopause

Since periods can be irregular in perimenopause, it can be difficult to know when your last period is, so you are said to be post-menopausal when you have not had a period for one year. After this, you will be post-menopausal for the rest of your life. When you are post-menopausal vaginal bleeding is not normal, so speak to your doctor right away if you get any bleeding.

There are some common symptoms of menopause, which can help you to tell when you are in menopause.

This includes:

• reduced libido (sex drive)
• hot flushes
• vaginal dryness
• discomfort when having sex
• night sweats
• low mood
• anxiety
• trouble sleeping
• problems with concentration or memory
• weight gain

During peri-menopause, you may get irregular periods, spotting, or your periods may be lighter than normal. Symptoms can happen years or months before your periods become irregular and stop, and may last for around 4 years after menopause. Some women get symptoms for much longer.

For most women, the symptoms and change in periods can give a good idea if you are in the menopause without taking a test. Our menopause test works by testing how much FSH (follicle stimulating hormone) is in your blood. This test alone cannot tell you if you are in the menopause. But, our doctors will be able to give you more advice based on the test result, when your last period was, and how old you are.

A menopause test may be useful if you are 40 to 45 years old and have menopausal symptoms. It can also be useful if you are over 50 years old and using progestogen-only contraception (like the mini-pill, the Mirena coil, or the implant) and you are not having periods. It can help to work out when you can stop using this contraception.

If you are using the combined pill, HRT, or other hormone treatments with oestrogen and progestogen together, the menopause test is not recommended. This is because all these treatments can change hormone levels.

If you have had a period in the last 12 months and are having symptoms, the test might give an indication if you are in the perimenopause, but it is less accurate in this time. This is because during the peri-menopause the hormone levels can change a lot from day to day. The test result cannot tell you when you will stop having periods.

The kit is easy to use and includes a lancet, so you can take a blood sample from your finger. The blood should go into the sample tube provided and can be sent to a lab. Your results will be available through your online account. If you still have periods, do this on the third day of your period.

As with most medications, HRT may cause some side effects. Most of these will go away within the first 3 months of getting treated.

Common side effects of HRT include:

• nausea (feeling sick)
• headaches
• tender breasts
• indigestion
• vaginal bleeding
• stomach pains
• leg cramps
• acne
• depression

If your symptoms last longer than 3 months or are severe, speak to your doctor. To help with these side effects, try taking your HRT with food, if you are taking it in tablet form. Eating a low-fat diet can help with breast tenderness and regular stretching can help with leg cramps. Some women may gain weight whilst taking HRT but this is likely to be a symptom of menopause, rather than HRT.

HRT is a suitable treatment for most women going through menopause. It may not be the right treatment for you if you have:

• a history of blood clots
• a history of womb, ovarian, or breast cancer
• liver disease
• had a heart attack or angina recently
• untreated high blood pressure, as your blood pressure must be within normal limits before starting certain types of HRT

You should not use HRT if you are pregnant or breastfeeding.

There are some risks of taking HRT but for most women the benefits outweigh the risks. There is an increased risk of having a stroke (a very small risk for women under 60 years old) and breast cancer, but this will depend on how long you are taking it for. The risk will also drop again after you stop taking HRT. For women who take tablets, rather than gels or patches, there is also a very small risk of blood clots.

You might not be able to use HRT if you are using certain medications. Make sure you let your doctor know if you are using any regular medications.

If you are not able to take HRT, or you are worried about the risks, there are other alternatives. You can help to control your menopausal symptoms by making some lifestyle changes.

These include:

• doing regular exercise
• cutting down on spicy foods, alcohol, and caffeine
• reducing your stress levels
• using lubricant or moisturiser for vaginal dryness
• stopping smoking
• eating a healthy, balanced diet
• keeping cool at night to reduce night sweats

Some women use natural remedies alongside HRT, or on its own, to help with symptoms. Some remedies, such as St John’s wort, have been known to help with hot flushes but there is not much scientific evidence behind natural remedies.

There are also some other medical alternatives to HRT, if HRT is not right for you:

• Veoza: A new menopause treatment that contains fezolinetant. This can be used to treat hot flushes and is currently only available through a private prescription. It’s recommended for women with moderate to severe hot flushes who can’t take HRT or want an alternative treatment. It works in the areas of your brain responsible for regulating body temperature.
• Tibolone: This is a prescription medicine similar to combined HRT. It can help with symptoms of menopause and can only be used for women in post-menopause.
• Clonidine: This is a prescription medicine taken 2 to 3 times a day. It can help with night sweats and hot flushes in menopause. It does not change the hormone levels like HRT does.
• Antidepressants: Some antidepressants can be used to help with hot flushes that are caused by menopause. This is something your doctor will discuss with you if other forms of treatment are not suitable.