Perimenopause & Menopause Treatment including HRT

What is the Menopause & HRT?

The average age of the menopause in the UK is 51 but women can experience symptoms before and after this.

Menopause (when your periods stop permanently and you're no longer fertile) is usually diagnosed:

If you are over 50 and haven't had a period for more than 12 months

If you are under 50 and haven't had a period for more than two years

These rules do not apply if you're taking hormonal contraception.

Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause and replaces hormones that are at a lower level as you approach the menopause.

It does not work as a contraceptive (unless you have a Mirena coil)

Benefits

The main benefits of HRT are that it can help relieve symptoms such as:

• Hot flushes
• Night sweats
• Mood swings
• Vaginal dryness
• And reduced sex drive

Many of these symptoms pass after a few years, but they can be unpleasant and taking HRT can offer relief for many women.

It can also help prevent weakening of the bones (osteoporosis), which is more common after the menopause.

Risks

Some types of HRT can increase your risk of breast cancer and blood clots although the benefits of HRT are generally believed to outweigh the risks.

All methods of HRT have some risk, although some are safer than others. For example transdermal preparations (where oestrogen is absorbed through this skin from a patch or cream) reduce the risk of blood clots when compared to oestrogen tablets.

Please see the NHS choice information pages on HRT which contains lots of information about the benefits, risks, different types of HRT and also alternatives.

www.nhs.uk/conditions/hormone-replacement-therapy-hrt

What does HRT consist of?

HRT can contain one hormone (oestrogen) or two hormones (oestrogen and progesterone)

The oestrogen is the hormone that aims to help your symptoms.

Progesterone prevent the wombs lining from thickening. If this were allowed to happen your risk of endometrial (womb) cancer would increase. Progesterone aims to largely eliminate this risk.

If you have had a hysterectomy you do not need to take the progesterone hormone because your womb has been removed. A Mirena coil also provides the progesterone needed as long as it has been inserted within the last 4 years.

How can HRT be given & how do you decide what type is best?

Once we know whether you need one or two hormones we think about how these hormones are given.

Oestrogen needs to be given every day to help improve symptoms.

Progesterone can be given every day (continuously) or for 2 weeks out of a 4 week period (cyclically).

A Mirena coil releases progesterone daily and for most women reduces vaginal bleeding. If you have a Mirena coil (inserted within the last 5 years) or have had a hysterectomy then you need to add oestrogen, either as a tablet, patch or gel.

If you have not had a hysterectomy and do not have a Mirena coil we tend to use progesterone daily if your periods have stopped for >1 year as this should result in less irregular bleeding.

If you are still having a regular cycle we use it for 2 weeks out of a 4 weeks period. During the 2 weeks break from the progesterone you should have a period.

There are different ways of taking HRT. These can include tablets, patches and oestrogen also comes as a gel.

Different preparations

For continuous HRT (when oestrogen and progesterone are both taken continuously) different preparations include:

Tablets – there are many different types, with each containing a progesterone and varying strengths of oestrogen. A single tablet is taken every day.

Patches – the patch should be applied away from breast tissue and generally changed twice a week (but always check the prescribing instructions)

Oestrogen gel and Utrogestan – this preparation is sometimes called “body identical” HRT because it mimics the body’s own hormones. The amount of get used can vary between 1 and 4 pumps daily depending on symptoms and response. This is generally applied in the morning (often to the thighs but definitely away from breast tissue) and Utrogestan 100mg (the progesterone tablet) is taken at night.

For cyclical HRT (daily oestrogen but a 2 weekly cycle of progesterone)

Tablets – again there are many different types. For the first 2 weeks each tablet will just contain oestrogen, and for the second 2 weeks each tablet contains oestrogen and also a progesterone. It is towards the end of this 4 week cycle that you should experience a period.

Patches – have a similar pattern to the cyclical tablets where for the first 2 weeks of a 4 week cycle the patches just contain oestrogen. Then for the second 2 weeks the patch should contain oestrogen and progesterone. Towards the end of the 4 week cycle you should experience a period. The patches should be applied away from breast tissue and generally changed twice a week (but always check the prescribing instructions)

Oestrogen gel and Utrogestan – oestrogen gel (1-4 pumps) should be used daily (generally in the morning and normally applied to the thighs but definitely away from breast tissue). For days 15-26 of each cycle Utrogestan 200mg should be taken at night.

As seen above there are lots of different preparations of HRT and it can be trial and error to find which one works best.

Different strengths of oestrogen can be used, along with different progesterone’s if needed.

You may also find that you experience some irregular bleeding, especially to begin with. If this doesn’t settle within 3 months please contact us for a review where we will discuss options, such as changing the hormones, the type of HRT or investigating further.

To discuss the menopause and its management further please call the surgery to book a telephone call with a GP.