Hormone therapy for menopause: experiences and what you should know

"Should I really start that?" It is the question almost every woman asks the moment hormone therapy comes up. Often with an undercurrent of doubt, fed by a story from an aunt or a newspaper headline from years ago. I understand that hesitation, but it is by no means always justified.

I believe women have a right to an honest, balanced account of hormone therapy, without scaremongering and without a sales pitch. This article does not give medical advice, but helps you enter the conversation with your GP prepared.

What exactly is hormone therapy?

Hormone replacement therapy, often shortened to HRT, tops up the hormones that fall during menopause, mainly oestrogen and, in women with a uterus, also progesterone. The aim is not to halt menopause, but to ease complaints that affect your daily life.

The NHG guideline for GPs describes HRT as an effective treatment for moderate to severe menopausal complaints, such as heavy hot flushes and night sweats. So it is not a cure-all, but for the typical vasomotor complaints it works well for many women. The NVOG, the professional body of gynaecologists, and Thuisarts also provide information on weighing hormone therapy, so you can make a choice that fits your situation.

What does it help with, and what not?

That last line is important. Before topping up your hormones, it is wise to check that your fatigue is not caused by something else. An underactive thyroid or a low ferritin causes complaints that resemble menopause. A check of your TSH can help rule that out.

Weighing the pros and cons

HRT is not suitable for everyone and, like any treatment, has pros and cons. Whether it suits you depends on your age, when you start, your complaints and your medical history. The weighing around, for example, breast cancer or thrombosis risk is nuanced and belongs in a conversation with your doctor, not in a table or a headline. What I want to leave you with: the picture has become far more nuanced in recent years than the scare stories of around 2002 suggested.

Questions to ask your GP

• Are my complaints severe enough to consider HRT, or are there other steps first?
• Which form suits me: patches, gel, tablets or local application?
• What are the pros and cons for me personally, given my history?
• How long do I use it and how do we taper off?
• Which checks are sensible while I am using it?

And testing, does that add anything?

A hormone test is usually not needed before starting HRT: the decision turns on your complaints. It can be sensible, though, to have a broader picture of your health beforehand, for example your thyroid, your iron and your cardiovascular values. A Menopause Check can provide such a baseline so you can have a better-informed conversation with your doctor.

What forms are there?

HRT comes in different forms of delivery, and that choice is not unimportant. The most common:

• Patches and gel. Oestrogen is absorbed through the skin. Many doctors prefer this because it bypasses the liver.
• Tablets. The classic form, simple to use.
• Local (vaginal) oestrogen. Specifically for complaints like vaginal dryness and recurrent bladder infections, with hardly any effect on the rest of your body.
• Progesterone. If you still have a uterus, oestrogen is combined with progesterone to protect your uterine lining.

Which form suits you depends on your complaints, your preferences and your medical history. This is very much something to discuss with your GP.

A common question is how quickly HRT works. With hot flushes and night sweats, many women notice a difference within a few weeks, though it can sometimes take longer to find the right dose. So give it some time and stay in dialogue with your doctor about what you notice. You can always stop again, in consultation and preferably gradually, so you can calmly see whether your complaints return.

And if HRT does not suit you?

Hormone therapy is not suitable or wanted for every woman, and that is fine. There are other ways to manage menopausal complaints. Enough exercise, attention to sleep, a cool bedroom and limiting triggers like alcohol and hot drinks can ease hot flushes. For vaginal complaints there are also non-hormonal lubricants and moisturisers. For mood complaints, counselling or, where needed, treatment can help. Discuss with your GP which route suits you, because even without hormones there is often much to improve.

A choice that is yours

Whether hormone therapy is right for you can only be decided together with your doctor, based on your complaints and your situation. What matters is that you make the choice from information, not from fear. To read more about what menopause does to your body, see our guide to perimenopause, or the article on osteoporosis after menopause.