Hormone Replacement Therapy (HRT)
What is HRT and how does it work?
HRT stands for hormone replacement therapy. Menopause leads to decline in ovarian function. Ovaries before menopause produce oestrogen and progesterone. Hormone replacement therapy aims to replace these hormones so that the symptoms caused by the lack of hormones are reversed.
Why do you need oestrogen and progesterone?
Oestrogen is needed to reverse symptoms of menopause and also support bones and heart. Progesterone counter-balances the effect of oestrogen on endometrium (lining of the uterus) and prevents excessive growth of the uterus.
What are the benefits of HRT?
Apart from reversing troublesome symptoms of menopause and improving quality of life, HRT also helps with prevention of osteoporosis (thinning of bones) and prevents cardiovascular events such as heart attacks.
What are the risks of HRT?
HRT has been associated with increased risk of breast cancer, but choosing an appropriate delivery of progesterone can mitigate this risk. Certain formulation of progesterone medication is associated with lowering of this risk. In fact, using Mirena intrauterine system to protect the endometrium may be a safer way to minimise increase in the risk of breast cancer.
Oral HRT medication is also associated with increased risk of thrombosis (blood clot) but using transdermal HRT (oestrogen gel or patch) is safe in this respect. There is also a slightly increased risk of stroke but this applies more to older women with medical co-morbidities.
How long can I carry on taking HRT?
HRT should always be taken under medical supervision and should be reviewed annually. With appropriate supervision, there is no reason why HRT cannot be continued at least up to 60 years of age.
What about local oestrogen?
The simplest treatment for vaginal dryness is to use a vaginal moisturiser on a daily basis. This will keep the vaginal epithelium moisturised and will reverse some of the symptoms. Additional lubrication may be required during sexual intercourse.
Other option is to use a very small amount oestrogen in the form of a vaginal pessary such as Vagifem. This is now licensed for unlimited use on a twice a week basis. Vaginal oestrogen creams are also available such as Ovestin. Quantity of oestrogen in these pessaries or creams is minimal (10 micrograms per day) and typical use is twice a week (approximately 1mg per year!).