Hormone replacement therapy (HRT)


HRT is the most common form of prescribed treatment for menopausal symptoms. It helps to replace the hormone estrogen in your body, which decreases around your menopause. You may sometimes also need other hormones that your body is no longer producing.
HRT should not affect your blood sugar control. If you are diabetic or have very high blood pressure, your healthcare professional may consult with a specialist before prescribing HRT.
If combined HRT is started before you have the menopause or within 12 months of your last period then you will be offered a ‘cyclical’ combined HRT, which should give you regular monthly withdrawal bleeds.
If you start combined HRT more than 12 months after your last period, you may be offered ‘continuous’ combined HRT (bleed-free HRT). You may experience some vaginal bleeding in the first 3 months, but after this it should stop.

Risks of Hormone replacement therapy

· HRT with estrogen alone is associated with little or no increased risk of breast cancer.
· HRT with estrogen and progestogen can increase your risk of breast cancer. This risk is higher the longer you stay on it and reduces when you stop HRT.
· Your individual risk of developing breast cancer depends on underlying risk factors, such as your body weight and your drinking and smoking habits.
· HRT taken as a tablet increases your risk of developing a blood clot, which is not the case if HRT is taken as a patch or gel.
· HRT in tablet form slightly increases your risk of stroke, although the overall risk of stroke is very low if you are under the age of 60 years.

HRT also comes as small pellet-like implants that are inserted under your skin (usually in the tummy area) after your skin has been numbed with local anaesthetic.
The implant releases oestrogen gradually and lasts for several months before needing to be replaced.
This may be a convenient option if you do not want to worry about taking your treatment every day or every few days. But if you still have your womb, you'll need to take progestogen separately too.
Types of HRT, Miami
There are have some types of Hormone Replacement Therapy. They are:
Intrauterine devices (IUDs) 
Itplaced inside your uterus by your doctor. A progesterone product, levonorgestrel (Mirena), is available in this form.
Skin creams and gels 
It applied to clean, dry, unbroken skin on your arms or legs. Never apply estrogen skin preparations to your breasts. Breast tissue can change in response to estrogen. Estradiol (Estrasorb, Estrogel) is available in this form.
Skin spray,
It applied to clean, dry, unbroken skin on your forearm. Estradiol (Evamist) is available as a spray.
Vaginal rings 
It inserted into the uppermost part of your vagina. They remain in place for 90 days at a time. Estradiol (Estring, Femring) is available as a vaginal ring.
Vaginal tablets 
It inserted into your vagina. Estradiol (Vagifem) is available in this form.
Treatment Reference

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