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Hormone Replacement Therapy (HRT)

Introduction

There is still much disagreement and conflicting evidence about the uses and safety of Hormone Replacement Therapy (HRT). Drug companies who manufacture HRT have much to gain from its widespread use. Claims that it is a cure-all for every mid-life problem have been common in the press and its benefits oversold and problems minimised.

On the other hand many women suffering with severe menopausal symptoms have undoubtedly been helped by taking HRT. It may be essential for some women who have had their ovaries removed or who have had an early menopause and are at risk of osteoporosis.

The experience of the menopause is very individual and the symptoms are temporary (usually lasting six months to two years). The symptoms can be helped in a variety of ways and HRT is one of the options. Every woman should be able to decide for herself whether or not to take HRT. Making the decision can only be done by comparing the pros and cons of taking HRT in the light of guidance from the Committee on Safety of Medicines and with the woman taking into account, her own particular needs, priorities and health background.

This leaflet gives general information about HRT. It does not give detailed information about the use of HRT after breast cancer. Women who have breast cancer should ask their specialist for advice on HRT.

What is HRT?

HRT is designed to increase levels of the female hormone oestrogen which fall as women go through the menopause, (this booklet does not look at the experience of the menopause in detail - for this, see the Women’s Health booklet on the Menopause).

Oestrogen is responsible for the development and maintenance of female sex organs and breasts and also helps to maintain the lining of the vagina and to keep other body tissues moist and flexible. The crucial difference between HRT and other hormonal treatments is that HRT is prescribed to counteract this natural reduction in the level of oestrogen which occurs at the menopause. In other cases, such as an underactive thyroid, hormonal treatment is given because glands are not functioning properly and a dangerous deficiency could result without treatment.

To justify and encourage the widespread use of HRT, some medical writers have referred to the menopause as a 'deficiency condition' as though it was an unnatural event. However, the menopause is not an illness.

Oestrogen production from the ovaries falls at the time of the menopause or following removal of, or damage to, the ovaries. But oestrogens continue to be made from other hormones in fatty tissues and in the adrenal glands. As the oestrogen from the ovaries fluctuates and declines during the menopause, the body goes through a period of readjustment. The menopause, rather than being a time of deficiency, could be providing biological protection. For example, oestrogen can promote the development of certain types of breast cancers, so a natural reduction in oestrogen circulating in the body could be an advantage.

Oestrogens are used in HRT to stabilise oestrogen levels in the body as oestrogen production declines. The oestrogens used may be synthetic or derived from the urine of pregnant horses (Premarin, Prempak-C, Premique, Premique Cycle) or from plants.

Progesterone is another female hormone which helps to bring about menstrual periods, prepares the womb to receive a fertilised egg, maintains pregnancy and affects the development of the breasts in pregnancy. It is added into HRT in the form of progestogen to prevent cancer of the womb lining (see cancer of the womb lining). There are various types of progestogens, some are derived from progesterone and some from testosterone.

Testosterone therapy has also been advocated by some doctors. Testosterone is mostly made by the ovaries and women who have had their ovaries removed during hysterectomy may notice a loss of sex drive. Testosterone supplements in the form of patches are an experimental therapy prescribed by some doctors alongside conventional HRT (i.e. oestrogen and progestogen) but they cause side effects, such as increase in body hair, and so they need to be used with caution.

Seeing the Doctor

HRT is not appropriate for all women. If you decide to take HRT you should have a number of initial tests which may include:

• breast examination
• internal pelvic examination
• blood pressure
• a test of thyroid function
• measurement of weight and height in order to determine body mass index (BMI)

While you are taking HRT your blood pressure should be checked every six months and you should continue having regular cervical smears and breast screening.

How do I take HRT?

There are many different ways to take HRT and many different combinations and dosages, all of which means that there are more options for women.

Tablets

Oestrogen is taken alone if a woman has had a hysterectomy (removal of the womb). It can also be taken with progestogen for a number of days each month, if she still has her womb (see bleed-free products).

When a progestogen is included, the treatment is called ‘opposed’ because progestogen opposes the effect of oestrogen on the womb lining. Oestrogen on its own can cause the lining of the womb to build up in thickness and so increase the risk of cancer. Progestogens prevent this build-up by causing the lining to be lost each month in the form of a bleed. This does not mean that fertility has been restored if you have stopped ovulating.

A disadvantage of tablets is that you have to remember to take them correctly. Another disadvantage common to all drugs taken by mouth is that a higher dosage must be taken to compensate for the loss which occurs as the drugs pass through the digestive tract. The high dose may lead to side effects such as nausea. Hormones taken by mouth also pass through the liver and so carry a greater risk of causing liver damage and gallstones.

Mirena for the progestogen part of HRT

This is an intrauterine system (a type of IUD) which contains a small amount of progestogen that thins the womb lining. It is a contraceptive which is also used for the relief of heavy periods. But it is likely to get a licence for HRT use because it can provide another way of getting the progestogen part of HRT. It works just inside the womb rather than affecting the whole body and may be a safer way of getting progestogen, see HRT Risks. It also has fewer side effects but it may not be suitable for everyone.

Patches

These are small plasters which are applied to the skin, they are available as single patches which contain oestrogen alone. The hormones pass directly from the patch across the skin into the bloodstream. The patch has to be changed once or twice weekly and a new one applied to clean, dry, hairless skin. If a woman has not had a hysterectomy, she will need progestogen in some form e.g. by using a double patch (containing oestrogen and progestogen) tablets or a Mirena coil.

The main advantage of the patch is that it contains a lower dose of oestrogen which is absorbed into the blood stream from the skin and so is less likely to cause nausea or affect the liver. Side effects can include skin irritation, swelling and blisters. However the matrix patches cause fewer skin reactions than the older reservoir type. An additional problem is that variations in the dosage absorbed from the patch can occur because of individual differences in the skin. The effects of long-term use of patches on the skin are not known.

Implants

These are small pellets containing oestrogen which are inserted under the skin. They usually contain a six-month supply of hormones and are inserted into the fatty layers of the abdomen, buttocks or thighs under a local anaesthetic. This means that the dosage is fixed for the specific time. If intolerable side effects occur, the implant has to be removed, but locating it may be difficult and removal may be painful. Implants can result in higher oestrogen levels than tablets or patches. With implants, the body may get accustomed to high oestrogen levels and as a result, some women may experience more side effects as the oestrogen in the implant runs out. However, some women find this a very convenient method as once the implant is in place they can forget about it. Women with a womb will need progestogen in some form as well.

Nasal spray

‘Aerodiol’ delivers oestrogen through the nasal passages creating a pulse of oestrogen. Unlike other HRT products it does not provide a constant dose of oestrogen throughout the day, but it is effective and easy to use. Women with a womb will also need progestogen.

Vaginal ring

Designed for women whose womb has been removed, ‘Menoring’ releases oestrogen into the bloodstream and treats symptoms like hot flushes and vaginal dryness. It is easy to insert and should be changed after three months. A user survey revealed that the vaginal ring is comfortable to wear and does not interfere with sex.

Creams

Oestrogen cream is put directly into the vagina in a measured dose with an applicator. The applied oestrogen has a local effect on the vaginal lining and is absorbed into the bloodstream. Because the oestrogen passes into the bloodstream, creams should only be used for short periods. If they are used for longer than 3-6 months, women who have not had a hysterectomy would need to take a progestogen.

Oestrogen cream will not work immediately — it should be applied for several days before attempting penetrative sex (oestrogen creams are prescribed to reduce vaginal irritation and soreness and should not be used as a lubricant). Unfortunately despite the use of oestrogen cream and/or HRT some women still find vaginal dryness a problem.

Gels

Oestrogen in gel form can be spread over the skin daily and acts in the same way as the patch. The advantage of a gel over a patch is that skin irritation is avoided. A disadvantage is that the gel must be used daily, whereas the patch only needs to be changed once or twice a week. Some women find the gel messy to use and women with a womb will need to take progestogen as well.

Bleed-free HRT continuous combined therapy

When progestogen is taken with the oestrogen on a cyclical basis (for 10-14 days of each oestrogen treatment cycle) most women will have a monthly bleed like a period. There are now some preparations that do not cause a bleed because the progestogen and oestrogen are combined in a continuous dose. Current bleed-free HRT formulations include Livial, Premique, Kliofem, Kliovance (this also contains a lower dose of oestrogen), Evorel Conti, Elleste-duet Conti, Climesse, Femoston-conti and Nuvelle continuous tablets.

Livial (tibolone) differs from the other preparations in that it is not a combination of oestrogen and progesterone but a single drug which combines the properties of both, as well as some of the properties of male sex hormones. Bleed-free preparations are not recommended in the first year after the last period. Women who are still having periods but are experiencing menopausal symptoms are prescribed cyclical HRT which causes a regular bleed. They may choose to change to continuous bleed-free HRT in their early fifties when it is thought that bleeding would have ceased naturally if they had not been taking HRT. Bleed-free HRT would also be appropriate for a younger woman who had no periods for a year and was experiencing menopausal symptoms. Another option is to take oestrogen continuously for three months and then take progestogen for 14 days (Tridestra). This creates a withdrawal bleed every three months.

What can HRT be used for?

The Committee on Safety of Medicines has issued guidance about the safe use of HRT for women aged 50 and over. Although some doctors say the advice is too cautious and the risks of HRT exaggerated, this advice will influence how doctors prescribe HRT for the time being. Research studies are very complex and open to criticism and not all doctors have interpreted the findings in the same way.

HRT can be used for the short-term relief of menopausal symptoms

HRT can be used as a short-term treatment to help women who have menopausal symptoms. These usually last around six months to two years or so, and include symptoms such as hot flushes and night sweats, a dry vagina, disturbed sleep, headaches, poor memory, panic attacks, loss of sex drive and aching joints. Some women have only minor symptoms whilst others can be severely affected. HRT is acknowledged as a beneficial treatment for hot flushes, night sweats and vaginal problems. Some women feel generally much better using HRT. But current safety advice is that HRT should be used for the shortest possible time at the lowest effective dose, with treatment reviewed annually in consultation with a doctor.

Bone health

HRT is no longer recommended as the first choice of treatment for the prevention of osteoporosis. HRT does protect against osteoporosis but the protection lasts only as long as women take HRT which in effect means long-term treatment. Though the increased risks are small, the longer that HRT is taken the greater the opportunity for risk.

Dietary and life-style measures are the best way to protect bones (see Preventing Osteoporosis). If treatment is needed other drugs will be tried first before HRT, but if these do not work, HRT may be appropriate. HRT can also be given to prevent osteoporosis in younger women who have been through a premature menopause.

Women who have a menopause before the age of 45 can take HRT until the age of 50, to counter menopausal symptoms and to prevent osteoporosis. It is thought that taking HRT before 50 does not lead to the increase in risks detailed in HRT Risks.

What are the Positive Effects and the Side Effects of taking HRT?

The positive effects of HRT

Evidence indicates that HRT controls hot flushes and night sweats which for some women can be a major problem. HRT also improves vaginal lubrication, relieving vaginal soreness due to dryness. Some women report that they generally feel better on it, that it improves mood and concentration, reduces joint pains and forgetfulness and increases sexual desire. Because of all this, some women want to stay on HRT for as long as they can despite the risks.

Osteoporosis
HRT reduces hip fractures. For example, in women aged 50 to 59, there are 1-2 cases of hip fracture for every 1,000 non-HRT users, compared to 0-1 cases for every 1,000 HRT users.

Colon Cancer
HRT also reduces the risk of colon cancer In women aged 50 to 59 there were 3 cases of colon cancer reported in 1,000 non-HRT users compared to 1 case less in 1,000 HRT users.

The side effects of HRT

As with any medication, some women experience unpleasant side effects from HRT. Others feel only positive effects.

Common side effects include breast tenderness, nausea, headaches, leg cramps, irregular bleeding, weight gain and bloating. Women are usually advised to persevere with HRT for 6 to 8 weeks to see if these symptoms subside. If unwanted side effects persist after this time, altering the dosage or changing the product, e.g. from tablets to patches may bring relief. But for some women, the side effects are unacceptable and they choose to stop HRT.

Less common side effects are reduced sex drive, depression, vaginal bleeding (other than the expected monthly bleed if progestogen is taken) pains in the chest, groin and legs. Adverse effects should always be reported to your doctor and those in the less common group are of more concern.

Inflammation and itching has sometimes been reported with skin patches. This seems to be less of a problem with the newer matrix patches.

Progestogens may cause various symptoms including swollen feet and ankles, premenstrual tension, weight gain, breakthrough bleeding (that is when bleeding occurs at times other than the expected monthly bleed) depression and jaundice. The last three in particular should be discussed with your doctor. Changing the type of progestogen may help as some progestogens cause fewer side effects as may the Mirena IUD which acts locally inside the womb.

Gallstones can enlarge especially with HRT tablets so women may need to change to a different form of HRT. HRT can also increase the likelihood of women developing gallstones.

HRT does not usually make blood pressure rise. Women with pre-existing high blood pressure which is being monitored and treated should be able to take HRT.

HRT after breast cancer

The advice on this is changing and it is thought that even short-term use of HRT may pose a risk for women with a history of breast cancer. The evidence is not clear but early results from a Swedish trial in 2004 suggest that HRT increases the risk of recurrent breast cancer. Women with menopausal symptoms should discuss options very carefully with their specialist.

Some cautions about the use of HRT

Diethylstilboestrol (DES)
DES is a synthetic oestrogen which was given to women from about 1940 through to 1975 to prevent miscarriage. There is no evidence that it reduced miscarriages, but it did cause reproductive health problems in some of the children born to women who took it. In addition, women who currently take or have taken DES are considered to be at increased risk of developing breast cancer. They should think very carefully about taking HRT which might add to this risk.

High levels of oestrogens
Some women have high levels of oestrogens in their bodies and replacement therapy is not necessary or advisable. A blood test for hormones should determine this.

Fibroids
These non-cancerous growths in the womb sometimes shrink after the menopause but oestrogen therapy may cause them to enlarge. Fibroids may need to be monitored with regular ultrasound scans. Women should talk to their doctor about cutting the HRT oestrogen dose to the bare minimum.

Circulatory disease
Oestrogen can affect liver-dependent blood clotting factors and platelets, so can aggravate existing disease.

Endometriosis
Tissue from the lining of the womb growing elsewhere in the pelvic area is stimulated by oestrogen.

Heart disease
HRT is not recommended for women who have heart disease or have had a heart attack.

Stopping treatment

HRT should be stopped gradually to avoid a recurrence of severe hot flushes. For instance, if on combined HRT, reduce the oestrogen dose by cutting the tablet in half, and then introduce pill-free days, but keep taking the progestogen as usual to avoid a build-up of the womb lining. Stopping HRT should be done in consultation with your doctor.

SERMS

Selective Oestrogen Receptor Modulators (SERMs) are a type of drug which act like oestrogen on certain parts of the body while blocking the effects of oestrogen in other parts of the body. Raloxifene (Evista) is a SERM (it is not HRT) which is used to prevent and treat osteoporosis in post menopausal women. There is evidence to indicates that raloxifene may reduce the risk of oestrogen sensitive breast cancer. However, raloxifene does not treat menopausal symptoms and can induce hot flushes, leg cramps and may cause a slight increase in the risk of blood clots similar to that of HRT. It does not reduce the risk of heart disease. Women should not take it if they have liver disease, unexplained vaginal bleeding, existing endometrial or breast cancer, a history of deep vein thrombosis or if they are still fertile.

HRT Risks

Recent research about the safety and benefits of HRT has changed medical advice about what HRT can be used for. HRT was recommended for the relief of menopausal symptoms, but it was also sometimes recommended to healthy women (without menopausal symptoms) as a long-term treatment to help prevent osteoporosis and offer protection against heart disease and other problems of ageing, such as Alzheimer’s disease.

The Committee on Safety of Medicines no longer recommends HRT is as safe to use for a long-term treatment because of safety concerns (detailed below). The concerns have been raised by recent studies including the Million Women Study (2003, UK trial) and the Women’s Health Initiative (2002, US trial).

Summary of risks from the Medicines and Healthcare Products Regulatory Agency and the Committee on Safety of Medicines
The increased risks of taking HRT are small. Women who do not take HRT can also develop these conditions. Any risk assessment needs to take into account a range of factors including life-style and family history.

Breast Cancer

• Women who do not take HRT: About 32 in every 1000 women aged 50 (who do not take HRT) will get breast cancer by the time they reach 65.
• Oestrogen only HRT: In women aged 50 who take oestrogen only HRT for five years, about 33.5 in every 1000 will get breast cancer. That is only an extra 1-2 cases. If they take it for ten years this could rise to 37 cases in a 1000. Results from the oestrogen only study form the Women’s Health Initiative released in early 2004 found that women who took oestrogen only HRT had no increased risk of breast cancer.
• Combined HRT started at age 50: The number of cases that would be diagnosed by 65 would be 38 cases in a 1000 after 5 years i.e. an extra 6 cases, and 51 in a 1000 after 10 years i.e. an extra 19 cases. Results from a recent Swedish study found that continuous combined ‘bleed-free’ products carried the highest risk.
• Tibolone: The risks of breast cancer have not been studied for this product but are thought to be between those for oestrogen only and combined HRT.

Cancer of the Womb Lining

Taking oestrogen only HRT makes the womb lining thicken, and this increases the risk of cancer developing. This risk is reduced (but not totally eliminated) by taking progesterone which gets rid of any excess womb lining in the form of a withdrawal bleed. Any abnormal bleeding which begins after starting HRT needs to be investigated.

Ovarian Cancer

Using oestrogen only HRT for more than 5 years may slightly increase the risk of getting this rare but serious cancer. It is not yet known what effect combined HRT has on ovarian cancer.

Heart disease

The latest advice is that HRT does not protect against heart disease as was previously thought. Also products which contain conjugated oestrogen (oestrogen from the urine of pregnant mares) and a type of progestogen called medroxyprogesterone may increase the risk of heart disease in the first year of use.

Stroke

HRT slightly increases the risk of having a stroke. For women in their 50s who do not take HRT about 3 in every 1000 will have a stroke in any 5 year period compared to about 4 in a 1000 women of the same age who take HRT for five years.

Stroke risk goes up with age. For women in their sixties who do not take HRT, about 11 in a 1000 will have a stroke over a 5 year period compared to about 15 in a thousand women who use HRT for five years.

Venous thromboembolism

Harmful clots can develop in the veins. If a clot develops in the deep veins of the legs it is called a Deep Vein Thrombosis (DVT). If a part of the clot breaks off and moves into the lungs it can cause a potential life threatening obstruction called a pulmonary embolism. The term venous thromboembolism (VTE) covers both deep vein thrombosis and pulmonary embolism.

Research shows that women who take HRT are more likely to develop a VTE than those who don’t, especially in the first year of using HRT: for women in their fifties who do not use HRT, about 3 in a 1000 will have a VTE over 5 years compared to 7 in a 1000 women of the same age who use HRT for 5 years.

Dementia

Contrary to what was previously thought, research currently shows that HRT has no beneficial effect on mental functioning and may increase the risk of dementia later in life.

Weighing up the risks

Despite the current safety recommendations, it is important to emphasise that the increase in risks identified by these studies is small (in a study done by the Imperial Cancer Research Fund, reported in the late 1990s, the risks linked to HRT rapidly reduced after stopping HRT and disappeared after five years). Each woman needs to discuss the pros and cons of HRT with their doctor to see if it is suitable for them. Some doctors may agree to prescribe HRT for longer for those women who feel that the benefits of HRT outweigh its risks.

Reducing HRT risk

At the moment some research suggests that oestrogen only products may have a lower breast cancer risk than combination products but this needs to be confirmed by further research. Many women need to take progestogen because they still have a womb. It may be safe to deliver progestogen with the Mirena device, although more research is needed to confirm this. Some doctors believe this might be a better option as the progestogen just acts in the womb rather than affecting the whole body.

Alternatives to HRT

Many women are interested in alternatives to HRT because of concerns about the side-effects and longer-term effects of HRT. Complementary therapies, along with dietary changes, can help with menopausal symptoms. It is important to tell your doctor if you are using any complementary therapies and to tell your therapist about any prescription drug use.

The women’s clinic at the Royal London Homeopathic Hospital reports that 70% of patients feel a definite improvement in menopausal symptoms whilst using homeopathic remedies, about 25% get some benefit and 5% notice no change in their symptoms.

Breast Cancer

Homeopathic remedies are widely available now from health-food stores and chemists but there are about 100 remedies which are used to treat menopausal symptoms so it is best to consult a qualified homeopath to find the best individual choice.

Some women find that herbal remedies are helpful. Again it is best to seek the advice of a qualified medical herbalist. Herbs need to be taken for at least three months to see if they help.

Nutritional approaches to relieving menopausal symptoms include oestrogen-like substances in plants known as phyto-oestrogens. Soya foods, linseed, alfalfa and mung beans all contain phyto-oestrogens. There are studies which show a reduction in hot flushes in women whose diets are high in phyto-oestrogens.

Some people advocate the use of natural progesterone cream for the relief of menopausal symptoms. There are few proper studies of natural progesterone cream — in fact it is not a natural product — but some women find it helpful. Proponents of the cream believe that menopausal symptoms are due not to oestrogen deficiency but to an imbalance between oestrogen and progesterone. The theory known as 'oestrogen dominance' is that too much oestrogen is produced: women aged over 35 may not ovulate every month and because progesterone is not produced in non-ovulatory cycles there is relatively more oestrogen in the body; similarly, after the menopause virtually no progesterone is produced but the body still produces some oestrogen. However there are some concerns about the cream, one of which is that it could increase the risks of breast cancer. For more details about the cream see details of the Natural Progesterone Information Service in the Resources section.

Is HRT right for me?

Some questions to ask:

• How troublesome are my menopausal symptoms?
• Can I make dietary or life-style changes that will help reduce the effects of the menopause?
• Should I be getting more support from my family to help me through the menopause?
• Are any of the cautions about the use of HRT mentioned in this booklet particularly relevant to me?

HRT Resources

Books

Is HRT Right For You? by Dr Anne MacGregor (Sheldon Press, 2003).
Written by a doctor with a special interest in women’s hormones, this is a comprehensive and balanced guide to the risks and benefits of HRT, with lots of information on the various HRT products.

Is it me, or is it hot in here? by Jenni Murray (Vermilion, 2001)
A useful and informative guide to the menopause and the pros and cons of HRT.

The New Natural Alternatives to HRT by Dr Marilyn Glenville (Kyle Cathie)
written by a psychologist and nutritionist, this takes a critical look at HRT and offers much information on alternative approaches.

For details of the guidance from The Medicines and Healthcare Products Regulatory Agency (MHRA) and the Committee on Safety of Medicines (CSM), see: www.mhra.gov.uk

The National Osteoporosis Society
Camerton
Bath BA2 OPJ
helpline: 0845 450 0230
www.nos.org.uk
Has information on all aspects of osteoporosis

Organisations

Many major hospitals have menopause clinics. You will need to be referred by a GP. To find your nearest clinic, either ask your GP or ring the Women’s Health enquiry line: 0845 125 5254 or the NHS information line: 0800 665544

The Menopause Amarant Trust
13 The Courtyard
East Park
Crawley
West Sussex RH10 6AG
helpline: 0901 607 0312, (Staffed by nurse advisor, premium rate 60 per minute)
www.amarantmenopausetrust.org.uk
Experts on HRT, but they advise also on all aspects of the menopause, including alternative approaches. They produce a Menopause Information pack that includes a list of menopause clinics, cost £6.

Breast Cancer Care
Kiln House
210 New Kings Road
London SW6 4NZ
helpline: 0808 800 6000
www.breastcancercare.org.uk
Offers support and information on all aspects of breast cancer and other breast conditions. Helpline is staffed by breast care nurses and trained volunteers who have had breast cancer.

NPIS offers information packs, books, tapes, videos and seminars about natural progesterone. It is not an advice service and cannot answer specific questions about the use of natural progesterone. For a products list, order form and information on how to obtain natural progesterone on prescription write to:
NPIS
PO Box 24
Buxton SK1 9FB
or phone: 07000 784 849
www.npis.info

To find a complementary practitioner contact these organisations:

National Institute of Medical Herbalists
56 Longbrook Street
Exeter EX4 6AH
(send a 47p sae for list of practitioners)
Telephone: 01392 426022
www.NIMH.org.uk

British Acupuncture Council
63 Jeddo Road
London W12 9HQ
Telephone 020 8735 0400
www.acupuncture.org.uk

The Register of Chinese Herbal Medicine
Office 5, 1 Exeter Street
Norwich NR2 4QB
Telephone: 01603 623994
www.rchm.co.uk

General Council and Register of Naturopaths
Goswell House
2 Goswell Road
Street
Somerset BA16 OJG
(Send £2.50 and a 31p sae for list of practitioners)
Helpline: 01458 840072

Aromatherapy Consortium
Ring 0870 7743477 for details of qualified therapists
www.aromatherapy-regulation.org.uk

British Homeopathic Association
Hahnemann House
29 Park Street West
Luton LU1 3BE
Telephone: 0870 444 3950
www.trusthomeopathy.org

For homeopathy on the NHS, ask your GP for a referral to the Women’s Clinic, Royal London Homeopathic Hospital in central London. There are also other homeopathic hospitals around the country.

Society of Homoeopaths
11 Brookfield
Duncan Close
Moulton Park
Northampton NN3 6WL
tel: 0845 450 6611
email: info@homeopathy-soh.org
web: www.homeopathy-soh.org
Publishes register of homoeopaths who are trained, insured and abide by the Society's Code of Ethics.

Written by Judy Fairlie and updated by Mary-Claire Mason for Women’s Health
and published in printed format by Women's Health

This leaflet is protected by Copyright © Women's Health. You may print off one copy for personal use only.