HRT. A topic that seems to come up in every conversation about the menopause, and a controversial one at that. Some praise HRT for its ability to alleviate the symptoms of hot flushes and night sweats, some avoid it entirely, and many remain in the middle, feeling they lack the knowledge to decide either way. 

But the confusion ends here. By breaking down the latest research and medical opinion on HRT, we’ve put together this article to demystify some of the confusion around HRT so that you can better understand whether it’s the right treatment option for you during your menopause.

What is HRT?

HRT (or hormone replacement therapy) is a treatment therapy widely used to relieve symptoms of the menopause. It works by providing a steady supply of hormones to your body to compensate for the declining levels of those being produced by the body during the menopausal years. The two main hormones used in HRT are oestrogen and progesterone, and these are usually prescribed in combination, unless you’ve had a hysterectomy. You'll usually start with a low dose, which may be increased at a later stage, based on which stage of the menopause they are in and other factors.

Most women can have HRT if they're experiencing symptoms associated with the menopause, however it may not be suitable if you have a history of breast cancer, ovarian cancer or womb cancer, blood clots, untreated high blood pressure, or liver disease.

How can HRT help to treat hot flushes?

HRT is considered an effective method of controlling many of the unpleasant symptoms of the menopause, including hot flushes. By balancing your hormone levels, HRT effectively stabilises your body’s thermoregulation, thereby keeping those pesky hot flushes and night sweats at bay. It can also help to regulate your mood, as well as prevent skin and vaginal dryness. HRT is also a good preventive measure against the deterioration of your bones — known as osteoporosis — due to the loss of oestrogen.[1]

Although it has been used to treat symptoms of the menopause since the 1960s, later research suspected there may be some risks associated with HRT. For example, HRT was said to increase the risk of developing certain cancers and other conditions. Since then, however, more comprehensive studies have concluded that the risks are not as great as they were once believed to be, a view that is supported by the medical community, including the Royal College of Obstetricians and Gynaecologists (RCOG). [2][3] 

Evidence from more recent research supports the view that HRT can be very beneficial for women seeking a solution for their menopausal symptoms, particularly women who are within ten years of their onset of the menopause and tare under the age of 60 who continue to experience symptoms. It’s available on the NHS as a very normal and viable treatment option, especially when more natural solutions have been unsuccessful. Nonetheless, many women opt not to try HRT because of the risks and side effects that have been associated with the treatment.[4]

What are the side effects of HRT?

As with most medicines, hormone replacements may come with some side effects, and it’s important to be aware of these before starting any new treatment. In the case of HRT, it is recommended that those who experience side effects try their best to endure them for at least three months to allow time for the body to adjust to this new wave of hormones. For most women, these side effects will reduce over time. 

Both oestrogen-based and progesterone-based HRT may cause side effects such as bloating, breast tenderness, nausea, headaches, vaginal bleeding, with progesterone-based treatments possibly also resulting in mood swings, depression, abdominal and back pain, and perhaps even acne.[1] These should subside after a few weeks; if, however, the side effects are severe or persist for longer than 3 months, you should consult your GP about the possibility of changing to a different method of delivery (i.e. switching from tablet to patch) or to a different dosage or type/combination of hormones.

There is also a wide-spread belief that HRT causes weight gain, but there is little medical evidence of this being the case. What may contribute to this belief is the fact that many women experience some weight gain during the menopause, but this is usually due to changes in metabolism or thyroid function that can occur regardless of HRT.[5]

What are some of the risks of HRT treatment?

Many women and doctors have been reluctant to turn to HRT due to the many studies since the late 1990s that have indicated a relationship between HRT and cancer, blood clots, heart disease, and more. However, the recent re-examination of past studies and new evidence suggests that the benefits of HRT may outweigh the risks.[6]

One factor to keep in mind is that the risks themselves vary depending on many variables, including the type of hormone and the length of the treatment. For example, women who take HRT for more than 1 year have a higher risk of breast cancer than women who never use HRT, however this risk is believed to reduce again when treatment is stopped.[7] For women who take HRT for less than 1 year, there is no increased risk of breast cancer.[7] 

Similarly, while there is a risk of developing issues such as blood clots, heart disease, or strokes on HRT, the actual numbers are very low. It's estimated that for every 1,000 women taking HRT tablets for 7.5 years, fewer than 2 will develop a blood clot.[7] If, however, you have an increased risk of any of these conditions due to genetic or other reasons, your GP can advise you on what the safer options may be for you. [7]

Which type of HRT is best for hot flushes?

Fluctuating or decreasing levels of oestrogen during the menopause are responsible for your body’s internal thermostat going haywire, so oestrogen is the key ingredient in solving the problem. The management of hot flushes (hot flashes) usually demands a high dose of oestrogen, significant enough to have an effect on the whole body. However, for most women this will be combined with a dose of progesterone, as taking oestrogen on its own can increase your risk of developing uterine cancer.[8] 

The way you take the hormones may vary, too, based on your preferences and requirements. Treatments are available in the form of tablets, skin patches, gels or creams, and even implants — you GP can help to advise you on the pros and cons for you in more detail.[9] Vaginal oestrogen, however, is one type of HRT that will not be effective for managing hot flushes. Since it is available as a cream, pessary or ring that is placed inside your vagina, this can help relieve vaginal dryness, but will not help with other symptoms such as hot flushes.

How long do I need to stay on HRT?

The recommended duration of HRT treatment to combat hot flushes is usually five years or less, but this can vary depending on each individual case. Your age, health, and medical history will all contribute to your doctor’s decision, as well as which stage of the menopause you’re in. You will need to have a comprehensive conversation with your doctor about these factors, as well as the frequency and intensity of your hot flushes, to determine the best course of action. If you decide to go ahead, you should notice an improvement within four weeks of beginning the treatment and feel its full effect within the first three months.

What can I do instead of HRT?

Instead of resorting to medication, you may find that the best way to get your hot flushes under control is in making fundamental lifestyle changes. A healthy diet geared to help you sleep, along with a regular exercise routine and mindfulness practices like yoga, can help naturally boost your serotonin levels and improve your mood and your sleep. Another method of reducing hot flushes would be to lower your intake of alcohol, caffeine, and spicy food, all of which are known triggers of hot flushes. If you are a smoker, giving up smoking is one of the best things you can do to keep hot flushes at bay whilst improving your quality of life during the menopause and drastically reducing the risk of many of the conditions you’ve been worrying HRT may cause. You could also try alternative therapies such as essential oils and aromatherapy to reduce stress and anxiety, which in turn may help to reduce the intensity of hot flushes when they occur.

Alongside health and lifestyle changes, cooling clothing is one tried and true method for alleviating the discomfort experienced during hot flushes and night sweats. The Anti-Flush Technology™ built into our silky, moisture-wicking fabric is designed to keep you cool in the moment when a hot flush strikes, and warm during the post-flush chills that follow. 

To discover more tips and advice, explore our Menopause Guide, and get the support you need to take on the ups and downs of the menopause.

References 

1. NHS UK, Hormone replacement therapy (HRT) (2020). Available at: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/ [accessed 20 Feb 2020]
2. Tomas Fait, Menopause hormone therapy: latest developments and clinical practice (2019). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317580/ [accessed 20 Feb 2020]
3. Royal College of Obstetricians and Gynaecologists, RCOG/BMS response to Lancet study on HRT use and breast cancer risk (2019). Available at: https://www.rcog.org.uk/en/news/rcog-bms-response-to-lancet-study/ [accessed 20 Feb 2020]
4. Angelo Cagnacci and Martina Venier, The Controversial History of Hormone Replacement Therapy (2019). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780820/ [accessed 20 Feb 2020]
5. NHS UK, Side effects  of hormone replacement therapy (HRT) (2020). Available at: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/side-effects/ [accessed 20 Feb 2020]
6. Royal College of Obstetricians and Gynaecologists, RCOG/BMS response to Lancet study on HRT use and breast cancer risk (2019). Available at: https://www.rcog.org.uk/en/news/rcog-bms-response-to-lancet-study/ [accessed 20 Feb 2020]
7. NHS UK, Risks of hormone replacement therapy (HRT) (2020). Available at: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/ [accessed 20 Feb 2020]
8.  Menopause Org, The Experts Do Agree About Hormone Therapy (2020). Available at: https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/the-experts-do-agree-about-hormone-therapy[accessed 20 Feb 2020]