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.
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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 both the Women’s Health booklet on the Menopause and our online leaflet The Menopause, Naturally).
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.
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