Hormone replacement therapy (HRT) is the practice of replacing oestrogen that is no longer produced during a woman's menopause. Replacing oestrogen lost through the ageing process minimises symptoms and protects against osteoporosis.
The menopause happens to every woman. It's the time of life when fertility, and therefore monthly periods, begin to cease.
Menopause can happen at a variety of ages. It usually starts around the age of 45 to 55 but some women can begin earlier in their thirties. When women begin menopause in their thirties it's often referred to as premature or early menopause, however, the symptoms and effects are the same as menopause that's begun in a woman's fifties.
As for women age, the amount of eggs in her ovaries decreases and the ovaries, therefore, produce less oestrogen. This happens gradually as does puberty. The transition period is called 'the peri-menopause' and many symptoms can begin to show at this time. It can take years for a woman to move from peri-menopause to a state of full menopause when egg release and fertility stops.
Some women can be severely affected by the menopause both physically and mentally. Some women worry about their sex appeal and attractiveness to their partners. Decreased oestrogen can affect emotions strongly. Physically the symptoms that women experience as they move into menopause include:
When peri-menopause ends and final menopause arrives, some women are at risk of the bone-thinning disease osteoporosis. Oestrogen builds strong bones so when production stops, it affects bone density causing bones to fracture or break easily. In severe cases, bones can fracture through slight falls or even coughing. Confirming that the menopause has taken place is difficult. Hot flushes and night sweats are common signs that the menopause is approaching but it can be tricky to tell when ovulation has stopped completely. It's a good idea to keep track of periods if you are experiencing menopause symptoms. Most doctors will say menopause has taken place if you have not bled for two years under the age of fifty or one year over the age of fifty. Women who have hysterectomies with ovary removal will experience an immediate menopause.
It's possible to manage menopause with lifestyle changes.
Women who are suffering from a decreased quality of life due to menopause, and have found no relief from natural methods, can look into hormone replacement therapy (HRT) for support.
Hormone replacement therapy (HRT) is the practice of manually replacing the oestrogen your body is no longer making. It's a clinically proven and effective way to manage menopause. HRT can be taken in several forms, but the most common is a daily tablet.
The type of HRT a woman needs is down to whether or not she still has a uterus and how severe her symptoms are. There are two types of HRT - oestrogen-only and combined which is oestrogen with progesterone. Your doctor is best placed to advise which is the most suitable.
Oestrogen is lost during the process of menopause and this type of HRT simply replaces what is missing. Oestrogen-only HRT is suitable for women without a uterus (women who have had a hysterectomy).
Combined HRT contains both oestrogen and progesterone. Both of these are sex hormones produced by women. Oestrogen is required to reduce menopause symptoms, but if a woman still has her ovaries they may be releasing oestrogen of their own. The small dose of progesterone in combined HRT ensures that oestrogen does not stimulate womb lining as this can lead to an overgrowth and potentially cancer.
HRT should only be taken when you cannot cope with the symptoms of menopause, and only at the lowest dose for the shortest time. All women taking HRT should be checked over by their doctor every year, more often if they have special conditions.
Oestrogen only HRT supplements your body with oestrogen. Women taking this form do not usually have a uterus so progesterone is not needed and a bleed will not occur. Examples of oestrogen-only HRT are Elleste and Evorel.
Cyclical HRT is a combined treatment that maintains the natural rhythm of your cycle. Oestrogen is taken in the first two weeks followed by two weeks of progesterone. You may experience a period (in reality a withdrawal bleed) when the progesterone dose is finished. Examples of cyclical HRT are Evorel Conti and Elleste Duet.
Continuous Combined HRT is an HRT that consists of both oestrogen and progesterone in one tablet or patch. The dose does not vary throughout the month and does not usually lead to a bleed. Examples are Elleste Duet Conti and Evorel Sequi.
HRT tablets are taken daily. In cyclical HRT you need to take the oestrogen tablets first. These are colour coded to help. With oestrogen only and continuous release HRT, the order does not matter. All tablets should be taken at the same time each day without a break. Swallow them whole with water and do not crush or chew the pills.
HRT patches are a discreet alternative to tablets and useful for women who do not like taking pills. A patch should be attached below the waist to a smooth area of clean dry skin twice a week. If you attach a dose on Monday you will need to change this on Thursday and again on the following Monday.
Hormone replacement therapy usually takes a few weeks to settle down. You should feel benefits after this time. Some women notice their symptoms easing within a week, but it can take up to three months for HRT's full benefits to take effect. If you are not feeling any benefits after three months speak to your doctor about a higher dose.
The length of time you'll need to take HRT varies with the individual. It's not recommended that women over the age of 60 start HRT, but those already taking it should continue if necessary.
If HRT is taken to obtain relief from menopausal symptoms then it can be taken for two to three years. Women often take this long to settle into menopause. If you've had an early menopause or your ovaries have been removed then the two to three year time period does not start until the age of 50.
When HRT is taken to prevent osteoporosis it generally needs to be taken for a minimum of five years.
All decisions about length of time you can take HRT should be made in consultation with your doctor. During the timeframe that you take HRT you should be offered regular check-ups to ensure your dose of HRT is still the right one.
Hormone replacement therapies are prescription only medicines to ensure you are safe. Taking hormones such as the pill or HRT is safe as long as you don't exceed your dose, you attend regular medical check-ups and are aware of the potential side effects.
HRT can interfere with how certain medicines work. If you need to take a short or long term course of treatments ask your doctor, pharmacist or dentist about its interaction with HRT.
Some medicines that are affected by HRT include epilepsy drugs, some antibiotics, HIV medications, drugs for high blood pressure in the lungs and the herbal remedy St John's Wort.
Your doctor will decide on the best course of action, but generally women with the following conditions should not use HRT:
Some health conditions and lifestyle choices may mean you cannot take HRT, but your doctor will decide whether the benefits outweigh the risks. Examples of these include being at an increased risk of blood clots - for example you smoke or are overweight, you have a relative with an oestrogen sensitive cancer, or you experience migraines, diabetes, asthma, epilepsy or endometriosis.
HRT can potentially cause side effects. Serious but rare side effects include the raised risk of blood clots. Oestrogen can make blood sticky meaning a blood clot could potentially form. If blood clots break free they can cause a heart attack or stroke. The risk is very low but it's exacerbated if you smoke or are overweight. Oestrogen in HRT may also raise the risk of breast and ovarian cancer. The risk is very low but if there is a family history it may be recommended that you don't use HRT. The risk of breast and ovarian cancer returns to normal after a few years of stopping the treatment.Oestrogen-only HRT can cause the womb lining to thicken potentially leading to cancer of the womb. Combined HRT reduces this risk with progesterone. Women aged over 60 may raise their risk of heart disease and stroke and women over the age of 65 have a slightly higher risk of memory loss if they use combined HRT. More common side effects of HRT include local skin irritation from HRT patches, emotional changes, insomnia, headaches, fluid retention and nausea. Rare but serious side effects include jaundice, migraines, increased blood pressure, painful rashes in the eyes, mouth and genitals and irregular vaginal bleeding. If you experience one of these rare side effects speak to your doctor before taking any more treatment. Always read the enclosed leaflet for a full list of common and rare side effects appropriate to your brand and application method of HRT.
HRT is not available over the counter. If you are struggling with the symptoms of menopause and think HRT will help, you will need a prescription from your doctor. This is because you may need a physical examination and an investigation into your personal and family medical history. Once you have been safely prescribed HRT by your doctor you can order it online from a reputable company.
Don't be tempted to purchase cheap HRT from unregistered sites that do not require a prescription. This puts your health in danger. The medicines issued by unregulated sites are not guaranteed and could harm you.
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