The menopause can cause various symptoms such as hot flushes
and changes to your vagina and genital skin. Hormone replacement therapy
(HRT) may ease symptoms. However, if you take HRT you have a small
increased risk of developing serious diseases such as breast cancer. If
you are considering taking HRT, you should discuss the risks and
benefits fully with your doctor. The lowest effective dose of HRT should
be taken. You should have regular follow-up to decide whether you still
need HRT. For most women who use HRT in the short-term for the
treatment of their menopausal symptoms, the benefits of treatment may
outweigh the risks.
What is the menopause?
Strictly
speaking, the menopause is your last menstrual period. However, most
women think of the menopause as the time of life leading up to, and
after, their last period. In reality, your periods don't just stop.
First they tend to become less frequent. It can take several years for a
woman to go through the menopause completely. Women are said to have
gone through the menopause (be postmenopausal) when they have not had a
period at all for one year.
What causes the menopause?
A
natural menopause occurs because as you get older, your ovaries stop
producing eggs and make less oestrogen (the main female hormone). The
average age of the menopause in the UK is 52. Your menopause is said to
be early (sometimes called premature) if it occurs before the age of 45.
Early menopause is uncommon.
There are certain things that may cause an early menopause. For example:
- If you have surgery to remove your ovaries for some reason, you are likely to develop menopausal symptoms straight away.
- If you have radiotherapy to your pelvic area as a treatment for cancer.
- Some chemotherapy drugs that treat cancer may lead to an early menopause.
- If
you have had a hysterectomy (removal of the uterus) before your
menopause. Your ovaries will still make oestrogen. However, it is likely
that the level of oestrogen will fall at an earlier age than average.
As you do not have periods after a hysterectomy, it may not be clear
when you are in 'the menopause'. However, you may develop some typical
symptoms (see below) when your level of oestrogen falls.
- An early menopause can run in some families.
- In some women who have an early menopause, no cause can be found.
Early (or premature) menopause is not discussed in detail in this leaflet.
What are the possible symptoms and problems of the menopause?
The
menopause is a natural event. Every woman will go through it at some
point. You may have no problems. However, it is common to develop one or
more symptoms which are due to the low level of oestrogen. About 8 out
of 10 women will develop menopausal symptoms at some point.
Short-term symptoms
These short-term symptoms
only last for a few months in some women. However, for others they can
continue for a few years after their last period:
- Hot flushes
occur in about 3 in 4 women. A typical hot flush lasts a few minutes
and causes flushing of your face, neck and chest. You may also perspire
(sweat) during a hot flush. Some women become giddy, weak, or feel sick
during a hot flush. Some women also develop palpitations and feelings of
anxiety during the episode. The number of hot flushes can vary from
every now and then, to fifteen or more a day. Hot flushes tend to start
just before the menopause, and typically persist for 2-3 years.
- Sweats
commonly occur when in bed at night. In some cases they are so severe
that sleep is disturbed and you need to change your bedding and night
clothes.
- Other symptoms may develop, such as headaches,
tiredness, being irritable, difficulty sleeping, depression, anxiety,
aches and pains, loss of libido (sex drive), and feelings of not coping
as well as before. It can be difficult to say whether these symptoms are
due to the hormone changes of the menopause. For example, you may not
sleep well or become irritable because you have frequent hot
flushes, and not directly because of a low oestrogen level. Also, there
may be other reasons why these other symptoms develop. For example,
depression is common in women in their 'middle years' for various
reasons.
- Changes to your periods. The time between
periods may shorten in some women around the menopause; in others,
periods may become further apart, perhaps many months apart. It is also
common for your periods to become a little heavier around the time of
the menopause.
Longer-term changes and problems
- Skin and hair. You tend to lose some skin protein (collagen) after the menopause. This makes the skin drier, thinner and more likely to itch.
- Genital area.
Lack of oestrogen tends to cause the tissues in and around the vagina
to become thinner and drier. These changes can take months or years to
develop.
- The vagina may shrink a little, and expand less easily during sex. You may experience some pain when you have sex.
- Your vulva (the skin next to your vagina) may become thin, dry, and itchy.
- Some women develop problems with recurrent urine infections.
Osteoporosis after the menopause
As you
become older, you gradually lose bone tissue. Your bones become less
dense and less strong. The amount of bone loss can vary. If you have a
lot of bone loss, then you have osteoporosis. If you have osteoporosis,
you have bones that will break more easily than normal, especially if
you have an injury such as a fall.
Women lose bone tissue more
rapidly than men, especially after the menopause when the level of
oestrogen falls. Oestrogen helps to protect against bone loss. By the
age of 70 some women have lost 30% of their bone material. In the UK,
about half of women over the age of 50 will fracture a bone, many as a
result of osteoporosis.
However, not all women develop
osteoporosis after the menopause. Osteoporosis is more likely to develop
if you have, or have had, one or more 'risk factors'. The following
situations are risk factors for developing bone loss and osteoporosis.
If you:
- Had your menopause before the age of 45 (a premature menopause).
- Have already had a bone fracture after a minor fall or bump.
- Have a strong family history of osteoporosis. (That is, a mother, father, sister or brother affected.)
- Have
a body mass index (BMI) of 19 or less. (That is, you are very
underweight.) For example, if you have anorexia nervosa. In this
situation your level of oestrogen is often low for long periods of time
and, combined with a poor diet, can affect the bones.
- Have a
time when your periods stop for six months to a year or more before the
time of your menopause. This can happen for various reasons. For
example, over-exercising or over-dieting.
- Have taken, or are
taking, a steroid medicine (such as prednisolone) for three months or
more. A side-effect of steroids is to cause bone loss. For example,
long-term courses of steroids are sometimes needed to control arthritis
or asthma.
- Are a smoker.
- Have an alcohol intake of four
or more units per day. (See separate leaflet called 'Recommended Safe
Limits of Alcohol' for details of what a unit of alcohol is.)
- Lack calcium and/or vitamin D (due to a poor diet and/or little exposure to sunlight).
- Have never taken regular exercise, or have led a sedentary lifestyle (particularly during your teenage years).
- Have,
or had, certain medical conditions that can affect your bones and
increase your risk of osteoporosis. For example, an overactive thyroid,
Cushing's syndrome, Crohn's disease, chronic kidney failure, rheumatoid
arthritis, chronic liver disease, type 1 diabetes or any condition that
causes poor mobility.
Cardiovascular disease after the menopause
Your
risk of cardiovascular disease (disease of the heart and blood
vessels), including heart disease and stroke, increases after the
menopause. Again, this is because the protective effect of oestrogen is
lost. Oestrogen is thought to help protect your blood vessels against
atheroma (small fatty lumps that develop within the inside lining of
blood vessels). Atheroma is involved in the development of heart disease
and stroke. After the menopause, your oestrogen levels drop and part of
this protective effect is lost.
One of the reasons for taking
HRT in the past was to help to protect against cardiovascular disease by
keeping oestrogen levels higher for longer. However, studies have since
shown that some forms of HRT do not actually protect against all
cardiovascular diseases and may actually increase your risk (see below).
Do I need any tests to see if I am going through the menopause?
Your
doctor can usually diagnose the menopause by your typical symptoms.
Hormone blood tests are not usually needed to confirm that you are going
through the menopause. However, they may be helpful in some cases. For
example, if your doctor suspects that you are going through an early
menopause, or if you have had a previous hysterectomy (and so are no
longer having periods).
Do I need treatment for the menopause?
Many
women do not have symptoms severe enough to require treatment. Only
about 1 in 10 women sees a doctor because of her symptoms. Without
treatment, the short-term symptoms discussed above last for 2-5 years in
most women. In some women they may last longer. Hormone replacement
therapy (HRT) is available to ease the symptoms of the menopause. It has
benefits and risks, which are discussed below.
There are
treatments other than HRT for menopausal symptoms. As a rule, they are
not as effective as HRT, but may help relieve some symptoms. (See
separate leaflet called 'Menopause - Alternatives to HRT' for details of menopausal symptom treatments other than HRT, which are not mentioned further here.)
All
types of HRT contain an oestrogen hormone. If you take HRT it replaces
the oestrogen that your ovaries no longer make after the menopause.
HRT
is available as tablets, skin-patches, gels, nasal spray or implants
(which are put under the skin). There are several brands for each of
these types of HRT. All deliver a set dose of oestrogen into your
bloodstream.
However, if you just take oestrogen then the lining
of your uterus (womb) builds up. This increases your risk of developing
cancer of the uterus. Therefore, the oestrogen in HRT is usually
combined with a progestogen hormone. The risk of cancer of your uterus
is very much reduced by adding in the progestogen. In many HRT products,
the oestrogen and progestogen are combined in the same tablet, patch,
implant, etc but they can also be taken separately. If you have had a
hysterectomy, you do not need a progestogen.
An option to ease symptoms just in the vaginal area is to use a cream, pessary, or vaginal ring that contains oestrogen.
How do I take hormone replacement therapy?
Different
women prefer different methods of taking HRT. For example, some women
prefer to wear a patch rather than take tablets. You doctor or practice
nurse can give you information about the pros and cons of the different
types of HRT. In general:
If you start HRT when you are still having periods, or have just finished periods
You will normally be advised to use a 'cyclical combined HRT' preparation. There are two types:
- Monthly
cyclical HRT - you take oestrogen every day, but progestogen is added
in for 14 days of each 28-day treatment cycle. This causes a regular
bleed every 28 days, similar to a light period. (They are not 'true'
periods, as HRT does not cause ovulation or restore fertility. The
progestogen causes the lining of the uterus to build up which is then
shed as a 'withdrawal' bleed every 28 days when the progestogen part is
stopped.) Monthly cyclical HRT is normally advised for women who have
menopausal symptoms but are still having regular periods.
- Three-monthly
cyclical HRT - you take oestrogen every day and then you also take
progestogen for 14 days, every 13 weeks. This means that you have a
bleed every three months. This is normally advised for women who have
menopausal symptoms but are having irregular periods.
You
may switch to a continuous combined HRT (see below) if you have been
taking cyclical combined HRT for some time but are now over the age of
54. This is because at least 8 in 10 women are thought to be
postmenopausal by the age of 54.
If you start HRT a year or more after your periods have stopped
If
your periods have stopped for a year or more, you are considered to be
postmenopausal. If this is the case, you will normally be advised to
take a 'continuous combined HRT preparation'. This means that you take
both an oestrogen and a progestogen every day. The dose and type of the
oestrogen and progestogen are finely balanced so that they usually do
not cause a monthly bleed. However, you may have some irregular bleeding
when you start taking this form of HRT. You should see your doctor if
this bleeding continues for more than a few months after starting HRT,
or if you suddenly develop bleeding after some months with no bleeding.
If you have had a hysterectomy
You will only
need to take HRT that contains oestrogen. The progestogen is only added
in to other types of HRT so that the lining of the uterus (womb) does
not build up and increase your risk of developing cancer of the uterus.
So, if your uterus has been totally removed, progestogen is not needed.
Note:
if you have had a subtotal hysterectomy (where the main part of your
uterus was removed, but your cervix was not) your GP may need to make
sure that there is no trace of uterine tissue left before prescribing
oestrogen-only HRT. It is not safe to take oestrogen-only HRT if you
have any uterine tissue remaining. Therefore, your GP may prescribe
cyclical combined HRT for three months or so. If you do not have any
bleeding during this time, it is unlikely that there is any uterine
tissue left and you can start oestrogen-only HRT.
If you mainly have genital symptoms
You may
choose to try for example, some vaginal oestrogen cream or a pessary to
help your symptoms. This alone may be enough to relieve symptoms in some
women who would prefer this option or who cannot take other forms of
HRT for some reason.
What are the benefits of hormone replacement therapy?
Menopausal symptoms usually ease
This can make a big difference to quality of life in some women.
- HRT tends to stop hot flushes and night sweats within a few weeks.
- HRT
will reverse many of the changes around the vagina and vulva usually
within 1-3 months. However, it can take up to a year of treatment in
some cases.
- There is no good evidence that HRT itself improves
your mood or your sleep. However, if you are anxious, irritable,
depressed, etc, at the same time as having menopausal symptoms, these
symptoms may also ease if symptoms such as hot flushes or a dry vagina
are eased. Therefore, there may be a 'knock-on' effect on your general
well-being after starting HRT.
If you take HRT long-term (several years or more)
Taking
either oestrogen-only or combined HRT may reduce your risk of
osteoporosis. You will have a reduced risk of breaking a bone,
especially your hip. However, the protective effect against osteoporosis
is small. HRT is not usually recommended as a first-line treatment for
osteoporosis as the risks (see below) are thought to outweigh the
benefits. But, if you are taking HRT for the treatment of, for example,
hot flushes and sweats, you will get this small knock-on benefit.
HRT
is also thought to produce a small reduction in your risk of developing
colorectal (bowel) cancer. However, HRT is not currently recommended
just for preventing colorectal cancer. Again, the risks outweigh the
benefits. But, if you are taking HRT for the treatment of, for example,
hot flushes and sweats, you will get this small knock-on benefit.
What are the risks in taking hormone replacement therapy?
There
has been a lot of media attention to the risks of taking HRT. This was
after the results of some big studies about HRT were published between
2002 and 2004. These were the Women's Health Initiative Study in the USA
and the Million Women Study in the UK. These studies raised concerns
over the safety of HRT, particularly over a possible increased risk of
breast cancer with HRT and also a possible increased risk of heart
disease. However, it is important that the results of the studies are
looked at carefully. HRT does increase your risk of developing
certain problems but this increase in risk is very small in most cases.
The risks of taking HRT are discussed below.
Venous thromboembolism
This is a blood clot
that can cause a deep vein thrombosis (DVT). In some cases the clot may
travel to your lung and cause a pulmonary embolism (PE). Together, DVT
and PE are known as venous thromboembolism. The risk seems to be higher
with combined HRT compared to oestrogen-only HRT and the risk is also
higher in the first year that you take HRT. This risk seems to be
slightly lower if you use HRT patches rather than HRT tablets taken by
mouth.
In women aged 50-59 years, over a five-year period:
- About 5 in 1,000 women who do not use HRT are likely to develop a blood clot.
- In 1,000 women taking oestrogen-only HRT for five years, there will be an extra two women who will develop a blood clot.
- In 1,000 women taking combined HRT for five years, there will be an extra seven women who will develop a blood clot.
In women aged 60-69, over a five-year period:
- About 8 in 1,000 women who do not use HRT are likely to develop a blood clot.
- In 1,000 women taking oestrogen-only HRT for five years, there will be an extra two women who will have a blood clot.
- In 1,000 women taking combined HRT for five years, there will be an extra 10 women who will have a blood clot.
(See separate leaflets called
'Deep Vein Thrombosis' and
'Pulmonary Embolism'
for further details.) You should see a doctor urgently if you develop a
red, swollen or painful leg, or have shortness of breath and/or sharp
pains in your chest.
Breast cancer
You may have a small increased
risk of breast cancer if you take HRT. Combined (oestrogen and
progesterone) HRT has a higher risk than oestrogen-only HRT. This risk
increases the longer you have used HRT. When you have been off HRT for
five years, you have the same risk of breast cancer as someone who has
not taken HRT.
In women aged 50-59 years:
- About 10 per 1,000 women who do not use HRT are likely to develop breast cancer over a five year period.
- In
1,000 women who are taking oestrogen-only HRT for five years, there
will be an extra two women who will develop breast cancer.
- In 1,000 women taking combined HRT for five years, there will be an extra six women who will develop breast cancer.
- About 20 per 1,000 women who do not use HRT are likely to develop breast cancer over a 10-year period.
- In 1,000 women who are taking oestrogen-only HRT for 10 years, there will be an extra six women who will develop breast cancer.
- In 1,000 women taking combined HRT for 10 years, there will be an extra 24 women who will develop breast cancer.
In women aged 60-69 years:
- About 15 per 1,000 women who do not use HRT are likely to develop breast cancer over a 5-year period.
- In 1,000 women who are taking oestrogen-only HRT for 5 years, there will be an extra 3 women who will develop breast cancer.
- In 1,000 women who are taking combined HRT for 5 years, there will be an extra 9 women who will develop breast cancer.
- About 30 per 1,000 women who do not use HRT are likely to develop breast cancer over a 10-year period.
- In 1,000 women who are taking oestrogen-only HRT for 10 years, there will be an extra 9 women who will develop breast cancer.
- In 1,000 women who are taking combined HRT for 10 years, there will be an extra 36 women who will develop breast cancer.
Stroke
Some previous big studies, including
those mentioned above, have shown that there is a small increased risk
of stroke in women taking either oestrogen-only or combined HRT. They
have shown that:
- In women aged 50-59 years:
- About 4 in 1,000 women who do not take HRT will have a stroke over a 5-year period.
- In 1,000 women who take oestrogen-only HRT for five years, there will be an extra one woman per 1,000 who will have a stroke.
- In 1,000 women who take combined HRT for five years, there will be an extra one woman per 1,000 who will have a stroke.
- In women aged 60-69 years:
- About 9 in 1,000 women who do not take HRT will have a stroke over a 5-year period.
- In 1,000 women taking oestrogen-only HRT for five years, there will be an extra 3 women per 1,000 who will have a stroke.
- In 1,000 women taking combined HRT for five years, there will be an extra 3 women per 1,000 who will have a stroke.
However,
a study was published in June 2010 in the British Medical Journal
(owned by the British Medical Association). It suggested that women
using HRT in the form of patches containing low doses of oestrogen
may not
have an increased risk of stroke compared with non-HRT users. In the
same study, those using HRT taken by mouth, or HRT patches with a higher
dose of oestrogen (more than 50 micrograms), were shown to have an
increased risk of stroke compared with non-HRT users. The increased risk
of stroke with those taking HRT tablets was about the same as that
shown in the previous studies mentioned above.
This was a big
study that looked at over 850,000 women in the UK. However, despite the
large numbers of women in the study, the number of women who actually
had a stroke was small and the number of women taking HRT at the time of
their stroke even smaller. Because of this, there needs to be some
caution in the interpretation of the study results because statistics
become less reliable the fewer the numbers involved. The study did take
into account things that may increase a woman's risk of stroke, for
example smoking, being overweight, high blood pressure or heart disease.
However, other factors may also come into play that the study could not
account for. For example, whether the women using the HRT patches with
low-dose oestrogen in the study may have been a group of more
health-conscious women who exercised more, ate more healthily, etc and
were therefore less likely to have a stroke anyway.
Saying that,
on balance, if you are considering taking HRT, this new study did show
that perhaps it may be safer in terms of your risk of stroke if you use
HRT patches containing low dose oestrogen rather than HRT tablets or
patches containing higher doses of oestrogen.
Coronary heart disease
Coronary heart disease
refers to disease of the coronary (heart) arteries. It is the usual
cause of angina and heart attacks. So far, studies have shown that
oestrogen-only HRT does not seem to increase your risk of
coronary heart disease. However, trials have shown that in women who
start combined HRT more than 10 years after their menopause, there is a
small increased risk of coronary heart disease. There are only a few
trials that have looked at younger women who have started HRT at an
earlier stage. However, some of these trials have suggested that these
women have a lower risk of heart disease with HRT compared to older
women and that HRT may even be protective.
Cancer of the uterus (womb)
There is an
increased risk of cancer of the uterus due to the oestrogen part of HRT.
By taking combined HRT containing oestrogen and progesterone, this risk
reduces significantly (see above). This is the reason why progestogen
is included in HRT. However, you should always see your doctor if you
have any abnormal vaginal bleeding which develops after starting HRT.
For example, heavy bleeding, irregular bleeding, or bleeding after
having sex.
If you have had a total hysterectomy for whatever reason, you should only need to take oestrogen-only HRT.
Cancer of the ovary
There is a slightly
increased risk of developing this cancer if you use oestrogen-only HRT
or combined HRT. This risk decreases after you stop HRT.
If
either combined or oestrogen-only HRT is taken for five years or less,
this increased risk is thought to be very small (there will be less than
one extra woman who develops ovarian cancer per 1,000 women taking
HRT). If HRT is taken for 10 years, there will be between 1-2 extra
women who develop ovarian cancer per 1,000 women taking HRT.
Dementia
If you start HRT after the age of
65, it is not thought to protect against dementia. Also, combined HRT
may increase the risk of dementia in women over the age of 75 years. HRT
is not advised to help prevent dementia.
Other points about risks
So, there is a small
but definite increased risk of serious illness when using HRT. But
note: your risk of developing the diseases mentioned above can depend on
a combination of many factors. For example, your family history, and
lifestyle factors such as smoking, obesity, diet, etc, can also affect
your risk. You can greatly reduce your risk of developing heart disease
and stroke by not smoking, taking regular exercise and eating a healthy
diet. These conditions become more common anyway with advancing age.
But, if you take HRT, this is now another factor to consider.
Are there some women who shouldn't take hormone replacement therapy?
The
risks of taking HRT are thought to outweigh the benefits for some
women. For example, HRT may not advised in the following cases:
- If you have a history of endometrial (womb) cancer, ovarian cancer or breast cancer.
- If
you have a history of blood clots (a DVT or a PE). If you have a
personal or family history of blood clots, your doctor may suggest doing
a thrombophilia screen (a blood test to look for any blood clotting
problems).
- If you have a history of heart attack, angina or stroke.
- If you have uncontrolled high blood pressure.
- If you are pregnant.
- If you have severe liver disease.
- If you have an undiagnosed breast lump.
- If you are being investigated for abnormal vaginal bleeding.
What about side-effects when taking hormone replacement therapy?
Side-effects
are problems that are not serious, but may occur in some women. They
tend to go if you stop treatment. Side-effects with HRT are uncommon.
Always read the leaflet that comes with the packet which gives a full
list of possible side-effects. Side-effects may include the following:
- In
the first few weeks some women may develop slight nausea (feeling
sick), some breast discomfort or leg cramps. These tend to go within a
few months if you continue to use HRT.
- HRT skin patches may cause irritation of the skin.
- Some women have more headaches or migraines when they take HRT.
- Dry eyes (lack of tears) are also thought to be more common in HRT users.
A
change to a different brand or type of HRT may help if side-effects
occur. Various oestrogens and progestogens are used in the different
brands. If you have a side-effect with one brand, it may not occur with a
different one. Changing the delivery method of HRT, for example, from a
tablet to a patch, may also help if you have side-effects.
So, should I take hormone replacement therapy, and for how long?
The
benefits have to be balanced against the risks. Some of the risks
associated with HRT increase the longer the time that you take HRT. You
have to decide what is right for you, with advice from your doctor or
nurse, depending on your circumstances. You tend to notice the benefit
from HRT once you have taken it for three months.
As a general rule:
For short-term treatment of menopausal symptoms
If
you are troubled with menopausal symptoms, the balance of risks and
benefits is probably in favour of taking HRT (provided there are no
reasons why you shouldn't take HRT). You may be happy to accept the
small risk of taking HRT for 1-3 years to be free of symptoms. You
should take the lowest dose which keeps symptoms away. Many women find
that after 1-3 years the worst of the flushing-type symptoms have gone
and they no longer need HRT to prevent them. In some women, the symptoms
can return for a short time after stopping HRT. If the genital symptoms
such as vaginal dryness persist after stopping HRT, an option is to
use, for example, an oestrogen cream or pessary in the vaginal area (see
below).
So, if women start HRT around the time of the menopause
to help symptoms, the risks are small. However, these risks increase
with age. Therefore, it is not usually appropriate for older women to
start HRT, as the risks are increased.
For healthy women without symptoms and a menopause at around 50 or over
If
you have little in the way of symptoms, HRT is usually not advised as
there is little to be gained, and even the small risks of HRT are then
unacceptable.
If you mainly have genital symptoms such as a dry vagina
An
option which may be advised by your doctor is to use, for example, a
vaginal oestrogen cream or pessary. This gives the benefits of easing
the symptoms, but with less risk than using HRT tablets, patches, etc,
as less oestrogen gets into the bloodstream. In some women, this
treatment may be needed long-term. Your doctor may suggest that you stop
the treatment from time to time to see if you still need it.
What about taking HRT to help prevent osteoporosis?
A
few years ago HRT was widely used to prevent osteoporosis. However,
recent research has shown that there are potential serious health risks
with taking HRT (described above). So, we now know that the balance of
risks and benefits for most women is usually not in favour of taking HRT
just to prevent osteoporosis.
However, if you have an early
menopause, HRT may be advised until you are aged 50. This is to help to
prevent osteoporosis (and ease menopausal symptoms if they occur). You
have an increased risk of developing osteoporosis if you have an early
menopause. Some of the health risks of taking HRT are thought to be
smaller until you reach the usual age of menopause (about age 50).
Stopping hormone replacement therapy
Your
doctor will usually follow you up regularly if you are taking HRT. They
may suggest a short period off HRT from time to time to see if you
still need it. For example, if you have been taking HRT for one to two
years and you have no symptoms, your doctor may suggest a trial of
stopping your HRT.
Some women do not notice any symptoms if they
stop HRT abruptly, while others may experience a recurrence of symptoms
such as hot flushes and sweats. These usually go after a few months.
Some experts suggest that HRT should be gradually reduced rather than
stopped abruptly.
Once your HRT has finished you may need some treatment for vaginal dryness (such as a cream or a lubricant).
You
may also need some treatment to prevent osteoporosis, such as
bisphosphonates, calcium and vitamin D supplements. (See separate
leaflet called 'Osteoporosis' for details.)
Some other points about hormone replacement therapy
- HRT
does not act as a contraceptive. Therefore, if you are still having
periods when you start HRT, or have only recently stopped having
periods, you should still use contraception. Your doctor will advise
when you no longer need to use contraception. But, as a general rule:
contraception should be used to prevent pregnancy for one year after
your last period if you are older than 50, or for two years after your
last period if you are less than 50.
- If you are taking HRT, you
should have regular check-ups with your doctor. This is so that you can
regularly discuss the risks and benefits of taking HRT for you, as these
may change over time. After some time, your doctor may also suggest
stopping your HRT to see if you still need it.
- You should also
be 'breast aware' and look out for any changes in your breasts. If you
notice any lumps or problems that you are worried about, you should see
your doctor. You should also attend your breast cancer screening
mammogram when called.
What is tibolone?
Tibolone is
a man-made hormone that can be used as an alternative to HRT. It has
some oestrogen, progestogen and also some androgen (male hormone)
effects. So, you just have to take this one tablet to have these hormone
effects.
The following are some points about tibolone:
- It is effective in treating sweats and hot flushes.
- It reduces your risk of osteoporosis.
- It may also improve your libido (sex drive).
- It is associated with a small increased risk of stroke.
- Most studies have shown a small increased risk of having endometrial (womb) cancer diagnosed in women who use tibolone.
- Tibolone
may be associated with a small increased risk of breast cancer. Studies
have also shown that tibolone increases the risk of breast cancer
recurrence in women with a history of breast cancer.
In
younger women, the risks of taking tibolone are about the same as taking
combined HRT. For women older than 60, the risks associated with taking
tibolone start to outweigh the benefits because of the increased risk
of stroke.
