What is hormone replacement therapy (HRT)?

By: Osler Health International
Posted on: 24 May 2022

Hormone replacement therapy (HRT) is a medical treatment that addresses declining estrogen and progesterone levels in women by replacing those hormones. It is usually administered to relieve menopause symptoms, including: 

  • Hot flushes 
  • Vaginal dryness
  • Night sweats 
  • Low libido 
  • Mood swings

Your doctor may also recommend HRT to prevent conditions that could result from falling hormone levels, such as osteoporosis and heart disease.

What are the types of HRT available?

There are primarily two main types of hormone replacement therapy: systemic and local. Systemic HRT is directly administered to your bloodstream and can come in the form of patches, tablets, gels, sprays and injections. Local HRT is administered to only one area of your body and can come in the form of creams, tablets or rings inserted into the vagina. 

Who can benefit from HRT?

While declining hormone levels are part and parcel of the ageing process, there are certain health conditions that may result in deficient hormone levels. If you have the following conditions, you may benefit from HRT: 

  • Menopause is a natural biological process that occurs when a woman has gone without a menstrual period for one year without being sick, on medication, pregnant or breastfeeding. Menopausal symptoms may begin years before or after menopause and can include vaginal dryness and itching, painful intercourse, hot flashes, night sweats and mood swings. HRT can help to relieve discomfort from those symptoms. We have a Factsheet that explains comon symptoms of menopause.
  • Estrogen deficiency due to:
    • Early menopause
    • Surgical removal of ovaries 
    • Primary ovarian insufficiency (Loss of ovaries’ function) 

If you experience the above conditions before age 45, your doctor may recommend hormone replacement therapy to replenish your estrogen levels. This could help to decrease your risk of medical conditions like osteoporosis, stroke, health disease and dementia. 

HRT is not a ‘one size fits all’ therefore it will normally be prescribed based on symptomatic need and a patient’s suitability. A doctor will ask about whether you:

  • Have high blood pressure 
  • Have a history of breast cancer, ovarian cancer, or cervical cancer
  • Have a history of blood clots
  • Have liver disease 
  • Are pregnant 

What are the risks of HRT?

The safety of HRT was called into question about 20 years ago when a study known as the Women’s Health Initiative reported increased breast cancer risk and heart disease from HRT. This had a major impact on menopause treatment practices which persists till this day. Since then, much higher quality research has been carried out and past findings have been re-analysed. 

The latest findings are that HRT is safe to use in most women – women with low underlying risk of breast cancer – if started in their 50s or who start HRT within 10 years of menopause. The risk of breast cancer with HRT is less than that with being overweight or drinking 2 or more units of alcohol a day. Most women will not be diagnosed with breast cancer as a result of their exposure to HRT.  The risk of blood clots while taking HRT is similar to that for other risk factors such as being overweight or cigarette smoking. There is in fact no increased risk of blood clots from HRT gels or patches. 

Caution with HRT use is advised in women with abnormal vaginal bleeding that has not been evaluated, and women with personal histories of breast cancer, established cardiovascular disease, or active liver disease. 

Speak to your doctor if you have any concerns about the risks of HRT. 

What are the alternatives to HRT?

If you are unable to, or decide not to get hormone replacement therapy, your doctor may prescribe alternatives to manage your menopausal symptoms: 

  • Lifestyle adjustments, such as exercising regularly, having a healthy diet, limiting consumption of caffeine, alcohol and spicy foods, quitting smoking and practising relaxation techniques 
  • Non-hormonal medication to relieve hot flushes and night sweats 
  • Vaginal moisturisers or lubricants to relieve dryness and pain during intercourse 

When should I see a doctor for HRT?

If you have uncomfortable menopausal symptoms and wish to consider hormone replacement therapy, see one of our doctors to determine the underlying causes of your symptoms. Remember that every woman’s menopausal journey is different, and the HRT course that worked for your friend may not be suitable for you. Speak to your doctor to understand your options and chart a personalised care plan that works best for you. 

For more information, please refer to our menopause and HRT factsheet

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