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. |
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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.
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