The Ultimate Guide on Hormone Replacement Therapy

Hormone Replacement Therapy or Menopause Hormone Therapy as it is also known, is the most common therapy prescribed by Doctors to treat the symptoms of Perimenopause and Menopause.

With up to 80% of women suffering with menopause symptoms such as hot flushes, night sweats, weight gain and irritability, hormone replacement

But you may have heard some negative stories about hormone replacement therapy. This article will cover:

1. What is Menopause?
2. What Age Do Women Go Through Menopause?
3. What is Hormone Replacement Therapy
4. Types of Hormone Replacement Therapy
5. Most Common Brands of Hormone Replacement Therapy
6. What Are the Signs That You Need Hormone Replacement Therapy
7. Hormone Replacement Therapy Side Effects
8. What Are the Risks of Hormone Therapy
9. Other Uses for HRT
10. What to Expect When Taking HRT for the First Time

1. What is Menopause?

Menopause is a natural biological process that marks the end of a woman's reproductive years. It typically occurs between the ages of 45 and 55, with an average age of around 51. Menopause is diagnosed after a woman has gone without a menstrual period for 12 consecutive months.

During menopause, a woman's ovaries gradually stop producing eggs and her hormone levels, particularly estrogen and progesterone, decline. This hormonal shift can cause a variety of physical and emotional changes as the body adapts to the new hormonal balance. The period leading up to menopause, known as perimenopause, is a transitional phase characterized by irregular menstrual cycles and hormonal fluctuations.

Common symptoms of menopause and perimenopause include:

Irregular periods:

Menstrual cycles may become shorter or longer, and the flow may become lighter or heavier.

Hot flushes:

Sudden waves of intense heat and sweating, often accompanied by a flushed face and rapid heartbeat.

Night Sweats:

Hot flashes that occur during sleep, leading to excessive sweating and disrupted sleep patterns.

Vaginal dryness:

Decreased moisture in the vaginal area, which can cause discomfort during intercourse and an increased risk of urinary tract infections.

Sleep disturbances:

Difficulty falling asleep or staying asleep, often due to night sweats or hormonal changes.

Mood changes:

Fluctuations in hormone levels can lead to mood swings, irritability, anxiety, and feelings of depression.

Changes in sexual function:

Reduced libido, decreased vaginal lubrication, and changes in sexual desire.

Other symptoms can include fatigue, memory problems, joint and muscle aches, weight gain, and changes in skin and hair texture.

While menopause is a natural process, the symptoms experienced can vary widely among individuals. If symptoms are bothersome or significantly impact daily life, various treatment options, including hormone replacement therapy (HRT) or non-hormonal therapies, can be considered to manage symptoms and improve quality of life. It's important to consult with a healthcare professional for personalized guidance and support during this transition.

2. What Age Do Women Go Through Menopause?

Most women have reached menopause by age 55. However Perimenopause can start as early as 45 years and can last as long as 14 years. There is a condition called 'Premature Menopause' which is any woman that goes into menopause before the age of 40. Women who go into menopause between the ages of 40 and 45 are said to have 'Early Menopause'.

Reasons for Early or Premature Menopause:

Premature menopause, also known as premature ovarian insufficiency (POI) or premature ovarian failure (POF), refers to the cessation of menstrual cycles and decline in ovarian function before the age of 40. The exact causes of premature menopause are not always clear, but several factors can contribute to its occurrence.

Here are some potential reasons for premature menopause:

Genetic factors:

Some cases of premature menopause may have a genetic basis. Certain genetic conditions, such as Turner syndrome or Fragile X syndrome, can be associated with early ovarian failure.

Autoimmune disorders:

Autoimmune diseases, such as autoimmune thyroiditis or systemic lupus erythematosus, can affect the ovaries and lead to premature menopause.

Chromosomal abnormalities:

Certain chromosomal abnormalities, such as X chromosome abnormalities, can result in premature ovarian failure.

Medical treatments:

Some medical treatments or interventions can damage or disrupt ovarian function, leading to premature menopause. These can include chemotherapy or radiation therapy for cancer, pelvic surgeries that involve removal of the ovaries, or certain medications.

Environmental factors:

Exposure to certain environmental factors, such as toxins, chemicals, or cigarette smoke, may increase the risk of premature menopause.

A Hysterectomy (including the removal of ovaries)

Most hysterectomies in Australia today only involve the removal of the uterus and not the ovaries to prevent women going into instant early menopause. But in some cases where:

• The ovaries are damaged
• There is an ovarian cyst
• Family history of ovarian cancer or breast cancer
• Chronic endometriosis

The ovaries may be removed, which will send a woman into menopause immediately.

In most cases where the ovaries are removed, your doctor will recommend hormone replacement therapy to ease symptoms of Menopause and to protect your bones from osteoporosis.

Family History

Women who have a family history of early or premature menopause are statistically more likely to go into early menopause.

Smoking

Regular cigarette smoking prematurely ages ovaries which causes early onset menopause. Smokers also report more severe menopausal symptoms such as hot flushes, night sweats, sleeplessness and irritability.

Unknown causes:

In many cases, the exact cause of premature menopause remains unknown. It is believed that a combination of genetic, environmental, and hormonal factors may contribute to its occurrence.

3. What Is Hormone Replacement Therapy?

Hormone Replacement Therapy is a medication that contains female hormones and is used to relieve the symptoms of menopause such as night sweats, hot flushes, irritability and vaginal dryness. The aim of hormone replacement therapy is to restore the levels of estrogen in the body. When a woman approaches menopause, her natural levels of estrogen drop, causing the menopausal symptoms. When these hormones are replaced in the body, it offers relief from these symptoms.

There are two different types of hormone replacement therapy:

• Combined HRT (which contains both oestrogen and progestogen)
• Oestrogen only HRT

HRT can be administered via a tablet, an implant inserted under anesthetic, a patch or a vaginal pessary. They come in a variety of strengths.

What is the Difference Between Oestrogen and Estrogen?

Oestrogen and Estrogen are exactly the same thing. Estrogen is used in most countries, however the United Kingdom predominantly uses Oestrogen.

4. Types of Hormone Replacement Therapy

There are different types of hormone replacement therapy (HRT) available, which can be tailored to an individual's specific needs and medical history. The two main types of HRT are:

Estrogen-only therapy (ET):

Estrogen-only hormone replacement therapy (HRT) is a type of treatment that involves supplementing or replacing estrogen in individuals who have undergone a hysterectomy (surgical removal of the uterus) and do not have a uterus. Since there is no risk of endometrial cancer in individuals without a uterus, estrogen can be used alone without the need for progestogen (synthetic form of progesterone) to protect the uterine lining.

Combined estrogen-progestogen therapy (EPT):

This type of HRT is prescribed to women who still have their uterus. It combines estrogen with progestogen (a synthetic form of progesterone) to protect the lining of the uterus and reduce the risk of endometrial cancer. EPT can be administered as continuous combined therapy or cyclic therapy. Continuous combined therapy involves taking both estrogen and progestogen continuously throughout the month. Cyclic therapy involves taking estrogen every day and adding progestogen for a certain number of days each month.

In addition to these two main types, there are other forms of HRT that may be prescribed in specific situations:

Tibolone:

Tibolone is a synthetic steroid that has estrogenic, progestogenic, and androgenic effects. It can be used as an alternative to estrogen and progestogen therapy in women who have gone through menopause and are experiencing symptoms. Tibolone is available in tablet form.

Testosterone Replacement Therapy:

Testosterone replacement therapy may be considered for women who have low testosterone levels and are experiencing symptoms such as reduced libido, fatigue, and decreased muscle mass. Testosterone can be administered through patches, gels, or injections.

It's important to note that the decision to pursue HRT and the specific type of therapy should be made in consultation with a healthcare professional. The choice of HRT depends on various factors such as the individual's symptoms, medical history, and personal preferences. A healthcare provider can help determine the most appropriate form, dosage, and duration of HRT based on an individual's unique circumstances.

5. Most Common Brands of Hormone Replacement Therapy Available in Australia

The most commonly prescribed HRT here in Australia include:

Angeliq

Angeliq is a combination of two hormones: drospirenone (a progestin) and estradiol (an estrogen). It is specifically for use in women who have not undergone a hysterectomy. It combines two active ingredients—drospirenone, which is a synthetic progestin, and estradiol, which is a bioidentical estrogen. The use of a bioidentical estrogen means that the molecular structure of the hormone is identical to the estrogen naturally produced by the body.

The Estradiol in Angeliq replaces the declining estrogen levels in menopausal women, providing relief from menopausal symptoms such as hot flushes. Drospirenone is a progestin that is added to protect the uterus from the potential risk of endometrial hyperplasia (overgrowth of the uterine lining) that can occur with estrogen therapy alone.

Angeliq is only available via a prescription from your GP.

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Femoston-conti

Femoston-Conti is a Hormone Replacement Therapy prescribed for the treatment of estrogen deficiency symptoms in postmenopausal women with an intact uterus. It is used to alleviate menopausal symptoms such as hot flushes, night sweats, vaginal dryness, and mood changes. The progestogen component helps protect the uterus from the potential risk of endometrial hyperplasia (overgrowth of the uterine lining) that can occur with estrogen therapy alone.

It contains two active ingredients—estradiol, which is a bioidentical estrogen, and dydrogesterone, which is a synthetic progestogen. The use of bioidentical estrogen means that the molecular structure of the hormone is identical to the estrogen naturally produced by the body.

Like all HRT's, Femoston-Conti is only available via a Doctor's prescription.

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Kliovance

Kliovance is a combination of two hormones: estradiol (an estrogen) and norethisterone acetate (a progestogen). It is primarily used for the treatment of moderate to severe vasomotor symptoms (hot flushes) associated with menopause in women who have a uterus. It is specifically approved for use in women who have not undergone a hysterectomy.

Kliovance is available in tablet form for oral administration. Each tablet contains a combination of estradiol and norethisterone acetate in specific doses. It replaces the declining estrogen levels in menopausal women, providing relief from menopausal symptoms such as hot flashes. Norethisterone acetate is added to protect the uterus from the potential risk of endometrial hyperplasia (overgrowth of the uterine lining) that can occur with estrogen therapy alone.

‍Bijuva

Bijuva is a brand name for a specific combination hormone therapy medication used for hormone replacement therapy (HRT) in postmenopausal women. It is a combination of two hormones: estradiol (an estrogen) and progesterone (a progestogen).

Bijuva is a treatment for moderate to severe vasomotor symptoms (hot flushes) associated with menopause in women who have a uterus. It is specifically approved for use in women who have not undergone a hysterectomy. It contains two active ingredients—estradiol, which is a bioidentical estrogen, and progesterone, which is a bioidentical progestogen. The use of bioidentical hormones means that the molecular structure of these hormones is identical to the hormones naturally produced by the body.

Estradiol in Bijuva replaces the declining estrogen levels in menopausal women, providing relief from menopausal symptoms such as hot flushes. Progesterone is added to protect the uterus from the potential risk of endometrial hyperplasia (overgrowth of the uterine lining) that can occur with estrogen therapy alone.

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6. What Are the Signs That You Need Hormone Replacement Therapy

Determining whether hormone replacement therapy (HRT) is needed is a decision that should be made in consultation with a healthcare professional. They will consider various factors, including symptoms, medical history, and individual circumstances. However, there are some signs and symptoms that may suggest a potential need for HRT.

Here are a few common signs that could indicate a potential benefit from hormone replacement therapy:

Menopausal symptoms:

If you are experiencing bothersome symptoms associated with menopause, such as hot flashes, night sweats, vaginal dryness, mood swings, sleep disturbances, or cognitive changes, HRT may help alleviate these symptoms and improve your quality of life.

Loss of bone density:

If you have been diagnosed with osteoporosis or are experiencing significant bone loss, hormone replacement therapy, particularly estrogen therapy, can help slow down bone loss and reduce the risk of fractures.

Early menopause or premature ovarian insufficiency:

If you have experienced menopause before the age of 40 (premature menopause) or your ovaries have stopped functioning prematurely (premature ovarian insufficiency), HRT may be recommended to manage symptoms, protect against bone loss, and provide potential cardiovascular benefits.

Surgical removal of the ovaries:

If you have undergone surgical removal of both ovaries (bilateral oophorectomy), you may experience symptoms of estrogen deficiency and may be a candidate for HRT to manage those symptoms.

Hormone deficiency-related conditions:

In some cases, hormone replacement therapy may be used to treat specific conditions related to hormone deficiencies. For example, testosterone replacement therapy may be considered for women with low testosterone levels who are experiencing symptoms such as reduced libido, fatigue, and decreased muscle mass.

7. Hormone Replacement Therapy Side Effects:

Like any medication, hormone replacement therapy does come with side effects. The most common side effects include:

Weight Gain

Weight gain is a potential side effect of hormone replacement therapy (HRT), although it does not affect all individuals undergoing HRT. The impact of HRT on weight can vary from person to person, and other factors such as diet, lifestyle, and individual metabolism also play a significant role in weight management.

Some factors related to HRT that may contribute to weight changes include:

Fluid retention:

HRT, particularly estrogen therapy, can cause fluid retention, leading to temporary weight gain and feelings of bloating. This weight gain is typically due to water retention and not an increase in body fat.

Metabolic changes:

Hormonal changes brought about by HRT can potentially affect metabolism. Some studies suggest that HRT, especially estrogen therapy, may contribute to a slight decrease in metabolic rate, which could impact weight management. However, the impact on metabolism varies among individuals.

Changes in fat distribution:

Hormonal changes can influence where fat is stored in the body. Some individuals may experience a shift in fat distribution with HRT, such as an increase in abdominal fat deposition, which can contribute to changes in body weight and shape.

It's important to note that weight gain during menopause is a multifactorial issue, and factors such as age, lifestyle changes, decreased physical activity, and changes in muscle mass also contribute to weight fluctuations.

Skin Irritation

Some hormone replacement therapies will cause skin irritation. For example some forms of HRT, such as patches, gels, or creams, are applied directly to the skin for absorption and in rare cases, these applications can cause skin irritation, redness, itching, or a rash at the application site.

Skin can also change with the hormonal fluctuations. Some people can experience dry skin, sensitivity or even a change in skin texture.

8. The Benefits of Hormone Replacement Therapy for Menopause

Hormone replacement therapy (HRT) is a medical treatment that involves supplementing or replacing hormones in order to alleviate symptoms caused by hormonal imbalances or deficiencies. While the benefits of HRT can vary depending on the individual and the specific condition being treated, here are some potential advantages:

Menopausal symptom relief:

HRT is commonly prescribed to women experiencing menopause or perimenopause. It can help alleviate symptoms such as hot flashes, night sweats, vaginal dryness, mood swings, and sleep disturbances. Estrogen replacement therapy, in particular, can be effective in managing these symptoms.

Improved bone health:

Estrogen plays a crucial role in maintaining bone density, and a decline in estrogen levels during menopause can increase the risk of osteoporosis and fractures. HRT can help slow down bone loss and reduce the risk of fractures in postmenopausal women.

Cardiovascular health:

Early initiation of HRT in women who are within ten years of menopause has been associated with potential cardiovascular benefits, including a decreased risk of heart disease. Estrogen may help maintain healthy cholesterol levels and arterial function, but the effects of HRT on cardiovascular health are still a topic of ongoing research.

Relief from certain cancer-related symptoms:

HRT may be prescribed to individuals who have undergone surgical removal of the ovaries or who are receiving treatment for certain types of cancer. It can help manage symptoms related to hormone deficiencies, such as fatigue, hot flashes, and loss of libido.

Psychological well-being:

Hormonal imbalances can impact mood, leading to irritability, anxiety, and depression. For individuals experiencing hormonal fluctuations or deficiencies, HRT can potentially improve psychological well-being and enhance overall quality of life.

It's important to note that the decision to pursue HRT should be made in consultation with a healthcare professional. The potential benefits should be weighed against the individual's medical history, current health status, and any potential risks or side effects associated with hormone therapy.

9. What Are the Risks of Hormone Therapy?

Like any medication, Hormone Replacement Therapy comes with side effects and possible complications.

Hormone Replacement Therapy can:

• Increase the risk of developing breast cancer
• Increase the risk of blood clots in the legs or lungs
• Can cause nausea
• May cause fluid retention and bloating
• Can cause breast tenderness
• Can cause irregular menstrual periods

But Hormone Replacement Therapy can also benefit women by:

• Preventing the onset of osteoporosis
• Can prevent diabetes

According to Health Direct.gov.au, the international recommendations on Hormone Replacement Therapy say that the benefits outweigh the risks for women who are having significant symptoms from menopause and that HRT is effective and safe for most healthy women.

Before being prescribed Hormone Replacement Therapy, your Doctor will ask you if you have had any of the following conditions:

• Blood clots in the legs or lungs
• Heart Disease or Stroke
• Untreated high blood pressure
• Breast Cancer
• Dementia

If you have any of these conditions, your Doctor may be reluctant to prescribe you Hormone Replacement Therapy and will make alternative suggestions depending on your condition.

10. Other Uses for Hormone Replacement Therapy

HRT isn't just used to treat menopause. Estrogens are also found hormonal birth control such as the pill. Transgender women, intersex people and nonbinary people also use HRT as a 'feminizing hormone therapy'. Feminizing hormone therapy encourages female sexual characteristics that aren't related to the reproduction system such as developing breast tissue, reduces facial hair and the prominence of the Adam's apple.

The Contraceptive Pill contains both estrogen and progesterone. The estrogen component controls menstrual bleeding, whilst the progesterone is the female hormone that prevents pregnancy. The 'Mini Pill' is a contraceptive pill that only contains progesterone. Progesterone works by making the vaginal mucus near the cervix 'thick' so that sperm cannot meet the egg in the uterus.

11. What to Expect When Taking Hormone Replacement Therapy for the First Time

When starting hormone replacement therapy (HRT) for the first time, it's common to have questions about what to expect. The effects and experiences can vary from person to person, but here are some general aspects to consider:

Symptom relief:

One of the primary goals of HRT is to alleviate menopausal symptoms such as hot flashes, night sweats, vaginal dryness, mood swings, and sleep disturbances. Many individuals experience a reduction in the frequency and intensity of these symptoms over time.

Hormonal adjustments:

HRT introduces exogenous hormones into the body, which can cause hormonal adjustments as your body adapts. This period of adjustment can vary from a few weeks to a few months. During this time, you may experience temporary changes in mood, energy levels, or menstrual bleeding patterns (if applicable). These adjustments usually stabilize as your body adjusts to the new hormone levels.

Improved vaginal health:

If vaginal dryness was a concern, HRT can help improve vaginal moisture and reduce discomfort during intercourse. It can also help maintain the health of the vaginal tissue.

Bone health:

HRT, particularly estrogen therapy, can help slow down bone loss and reduce the risk of osteoporosis and fractures. It can contribute to maintaining or improving bone density.

Emotional well-being:

Hormonal imbalances can affect mood and emotional well-being. HRT may help stabilize mood, alleviate symptoms of anxiety or depression, and improve overall emotional well-being.

It's important to remember that the effects of HRT can take time to manifest, and individual responses can vary. Some individuals may experience noticeable improvements in symptoms within a few weeks, while others may require a longer duration for noticeable changes.

Regular monitoring and follow-up with a healthcare professional are essential to assess the effectiveness of the treatment and make any necessary adjustments. They can provide personalized guidance and support throughout your HRT journey.

Sources:

• ‍Mayo Clinic
• ‍Australasian Menopause Society‍
• NPS Medicine Wise

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