Hormone Replacement Therapy (HRT)

Hormone replacement therapy aims to restore the level of hormones normally released by your body before the menopause.

The common hormones that may be used in your tailor made recipe can change with time but can include:

• Oestrogen
• Natural Progesterone
  we try to avoid artificial progesterones
• Testosterone
• DHEA
• Melatonin
• Vitamin D
• Pregnenolone
• Thyroxine

Various HRTs can be given as tablets, lozenges that dissolve under the tongue, gels or creams that are applied to arms or legs, or patches.

Local Oestrogen HRT can be used to maintain the vaginal and vulval skin and to improve badder function. This can be in the form of a cream, a vaginal pessary, or a vaginal ring that is changed every 3 months.

The earlier that HRT is prescribed in the peri-menopause, the greater the advantages of use. I am reluctant to start full HRT when the menopause has occurred more than 5 years previously, but treatment can be adapted to suit depending on the circumstances and your symptoms.

During your first consultation, you will discuss your medical history, and your family history. These will have a crucial influence on whether HRT is appropriate for you, and which type is best.

We aim to keep to the lowest effective doses, and use the safest formulations to minimise any potential risks.

If your family history includes several members with breast, ovarian, uterine, prostate or colon cancer, or if there is a strong family history of blood clots, then we may recommend additional tests for you such as genetic screening for the BRCA gene ( and other genes linked to an increased tendency to cancer), or genetic clotting problems.

The use of oestrogen alone causes little or no increase in the risk of breast cancer (NICE guidelines 2015).

The use of synthetic progestogens may increase the risk of breast cancer whilst you are on treatment. There is growing scientific evidence that this is not the case when natural progesterones are used.

More long term, well designed scientific studies are required to assess both the risks and benefits of the various types of HRT.

The large American WHI study in 2002 which suggested a significant rise in the incidence of both cardiovascular events such as heart attacks and stroke, and breast cancer, in women taking HRT has now been refuted because of poor study design, but at the time many women worldwide were refused HRT. Thankfully now we have better and much more positive information about the low risk and many benefits of HRT.

All my ladies have an annual mammogram for the first 5 years of treatment and regular breast checks annually thereafter, along with a mammogram every 2-5 years as appropriate.

When you first start we see you after 6 weeks, then as required to deal with any problems.

Blood hormone levels are monitored every 6-12 months and your prescription adjusted as necessary.

An annual gynaecology review is recommended until 65 yrs for your smear test and blood screening tests, then every 2 years if you are well.

A bone scan is arranged at the start and repeated every 5 years.

A pelvic scan is performed before starting and repeated every 5 years.