HRT (hormone replacement therapy) is medication that replaces the hormones that fall during menopause: Oestrogen, Progesterone and Testosterone.
Oestrogen – fluctuating and falling levels can give rise to many symptoms for women. Oestrogen is the main component of HRT. The Oestrogens used in HRT are referred to as "natural" because they resemble substances produced in the body and include oestradiol, oestrone and oestriol which are usually made from soya beans or yam extracts. Conjugated equine Oestrogens made from horse urine are also sources of the naturally occurring Oestrogen, oestrone sulphate.
Oestrogen can be taken by a daily tablet, twice weekly or weekly patch, daily gel or implant. People respond differently to different types, routes and doses of oestrogen and sometimes several adjustments of therapy are required. If possible, any type should be tried for 3 months before deciding whether or not a change is required.
Benefits of oestrogen
- Relief from hot flushes and night sweats
- Probable protection from heart attacks and heart failure
- Possible reduced risk of Alzheimer's disease
- Reduced risk of osteoporosis and fractures
- Beneficial cosmetic effect on skin, improved hair and nails resilience
- Relief from vaginal dryness and discomfort
- Improved sleep
- Improved and stable mood
- Possible lower risk of type 2 diabetes
- Lower risk of urinary tract infections
Progesterone – this is a silent but essential component added to oestrogen for women who still have their uterus – or sometimes after hysterectomy too -
For women in whom the uterus remains a progestogen is added to the oestrogen to reduce the risk of oestrogen causing thickening, and possibly cancer of the endometrium (lining of the womb). Progestogens are mostly made from plant sources and resemble the naturally occurring progesterone, usually produced from the ovary in the second half of the menstrual cycle. The two main types of Progestogen currently used in HRT are: those most closely resembling progesterone (dydrogesterone, drospirenone medroxyprogesterone acetate and micronised progesterone and those derived from testosterone (norethisterone, norgestrel and levonorgestrel).
If side effects are experienced on one type, changing the type or route of progestogen may help.
The duration and frequency of the progestogen determines the presence and pattern of bleeding and the type used is influenced by presence or absence of periods and age.
HRT in the Perimenopause: If HRT is commenced in the early stages of ovarian decline when periods are still present (the perimenopause), oestrogen is taken every day and progestogen for 10 to 14 days per month (sequential HRT). This cyclical progestogen induces a monthly withdrawal bleed in about 85% of women.
HRT in the Postmenopause: If periods have been stopped for more than 1 year (postmenopause) before starting HRT, or the woman is aged 54 or more, progestogen can be taken every day along with the oestrogen (continuous combined HRT). Continuous combined, or period-free HRT, may cause some bleeding in the first 6 months, but should not induce bleeding thereafter.
Testosterone
Many people think of it as the “male” hormone which is true, but women produce testosterone too.
Testosterone is made in the ovaries and adrenal glands, which are small glands near the kidneys. and therefore there is a lifetime - although dwindling - supply. It would be unusual for a woman who is still having periods to have “low” testosterone levels.
Currently, the only indication for prescribing testosterone is low libido.
Anecdotal evidence (ie not, as yet, supported by robust research) suggest some women find improvement in energy, stamina, mood or cognition.
Female sexuality and desire are very complex and not well understood. For many women testosterone levels have no bearing upon their libido, and supplementing testosterone certainly doesn't work for every woman either.
In response to increasing interest, The British Menopause Society have updated their guidance regarding testosterone prescribing and a factsheet reflecting this guidance is published on the public arm of the British Menopause Society – Women’s Health Concern.
