What is HRT? | You and Your Hormones from the Society for Endocrinology (2023)

What is HRT? | You and Your Hormones from the Society for Endocrinology (1)

What is hormone replacement therapy?

As the name implies, hormone replacement therapy (HRT) is a replacement of female sex hormones in women. These hormones are called oestrogen and progesterone. They are released from the ovaries and influence changes in the body’s cycle which controls periods, moods and a sense of wellbeing and health. Oestrogen is also very important to maintain strong, healthy bones and help prevent osteoporosis.
In a healthy woman of childbearing age, hormones are produced and released from the pituitary gland in the brain, including LH (luteinizing hormone) and FSH (follicle stimulating hormone). LH and FSH encourage the ovaries to produce an egg (ovum). At the same time, oestrogen and progesterone are released from the ovaries. These hormones prepare the endometrium (womb) for a pregnancy. If pregnancy does not occur, these hormone levels fall and the woman will have a period.

After the menopause, the ovaries no longer respond to stimulation by the hormones from the pituitary gland and stop producing eggs and oestrogen. Due to low oestrogen, progesterone and inhibin levels, there is a loss of negative feedback on the hypothalamus and pituitary gland, such that FSH (and LH) are markedly increased.

The menopause means that a woman can no longer become pregnant. In the approach to menopause, her periods either stop abruptly, or they may decrease more gradually over months, or even years. Irregular periods in the lead up to menopause is termed the ‘climacteric’.

‘Peri-menopause’ refers to the time within 12 months of the last menstrual period, whereas Post-menopause refers to the time thereafter.

At this time symptoms may appear, including:
- Hot flushes
- Night sweats
- Insomnia
- Palpitations
- Mood changes
- Vaginal dryness and painful intercourse
- Mild skin changes such as dryness and loss of elasticity
- Joint and muscle stiffness
- Changes in concentration levels

Treating women with HRT replaces the hormones that are no longer being released from the ovary and can relieve some of the symptoms associated with the menopause, enabling the woman to feel better, both physically and mentally.

When can hormone replacement therapy be used?

Most women have their menopause between 45-55 years of age, with the average age being 51. Some women go into an early menopause before they are 40 yrs old, termed premature ovarian insufficiency (POI).

(Video) Hormone Replacement Therapy (HRT) in menopause

Most women are postmenopausal by the age of 54 years. The symptoms of the menopause usually last between one and five years and vary between individuals. Less commonly women will still experience hot flushes at 10 years after their menopause began, whereas others may not have hot flushes at all. Some symptoms can gradually disappear without any treatment, but for others, symptoms can be so severe that HRT treatment may need to be for a prolonged duration.

Women who commence the menopause early before the age of 40 years have ‘premature ovarian insufficiency’ (POI). Other triggers that are associated with earlier menopause, including underlying medical conditions (e.g. Addison’s disease), autoimmune diseases, some infections, or previous cancer treatments such as certain types of chemotherapy or radiotherapy to the pelvic area.

What types of therapy are there?

HRT can be given by tablets, patches, creams or gels under advice from a GP, or a Menopause specialist.
HRT can take different forms:

• Oestrogen only; suitable for women who do not have a uterus (womb).
• Cyclical combined – which is both oestrogen and progesterone together and re-introduces monthly periods.
• Continuous combined – these prevent periods and may either be oestrogen and progesterone combined or Tibolone – a synthetic medication that has combined effects of oestrogen, progesterone and testosterone.

Women with an intact uterus must take combined HRT, replacing both oestrogen and progesterone, to prevent thickening of the lining of the womb and therefore reduce the risk of endometrial cancer of the womb. If a woman has had a hysterectomy (removal of the womb) then HRT can be oestrogen only.

For how long can hormone replacement therapy be given and what are the risks?

The current recommendations are for the lowest dose for the shortest possible time to control symptoms. Women who do not have symptoms of menopause should not use HRT. All types of HRT are linked with an increase in the risk of breast cancer, although this is very small (~0.01%), and can increase the risk of cancer of the uterus if progesterone is not also used. For some women who take combined HRT tablets, there may be an increased risk of developing a clot or having a stroke: this risk is much reduced if the HRT is in the form of a patch or a gel.

There are some benefits of HRT including strengthening the bones, which reduces the risk of osteoporosis and broken bones, but this reduction in risk is only during the time of taking HRT. HRT should not be used for long-term protection of osteoporosis. HRT also reduces the risk of getting bowel cancer but does not prevent heart disease, strokes or dementia.

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Women newly started on HRT should have their symptoms reviewed by their doctor after 3 months. Women who then remain on HRT should be reviewed at least every year by their doctor, discuss their signs, symptoms and wellbeing, and see whether continuing on HRT is still the best treatment for them.

Can symptoms be prevented from returning after HRT is stopped?

It has been suggested that slowly reducing the therapy dose over a period of months may help reduce the return of flushes, but there is no scientific evidence for this. Unfortunately, the symptoms will return if they are going to, whether therapy is stopped gradually or suddenly.

Active women may suffer fewer symptoms than inactive women, so regular exercise may help. Reducing alcohol and caffeine intake may help reduce hot flushes. Dietary changes can also help with symptoms, such as increasing foods rich in calcium and vitamin D, and reducing sugar intake. Some prescription medications from the doctor such as clonidine may help with hot flushes. Some antidepressants may also help the hot flushes and night sweats, although NICE guidelines state that there is no evidence that antidepressants will help with low mood.

Herbal medicines may help in some cases, especially as they may contain small amounts of plant oestrogens - phyto-oestrogens. Their value has not been confirmed, and often the amounts contained are so low that they are unlikely to be effective. Black cohosh, red clover, dong quai, evening primrose, St. John’s Wort and ginseng are among those that have been used, apparently with some success, but they should be taken in consultation with a GP because they may have a negative effect on other medication or may not be suitable for some women. In particular there have been concerns about the use of black cohosh because of its potential for liver damage. There is limited evidence of the general effectiveness of complementary therapies which can also include acupuncture, aromatherapy and other physical treatments. However, many women have found complementary medicine to be effective in relieving the symptoms and effects of menopause in individual cases. Cognitive behavioural therapy (CBT) has also been shown to help with menopausal symptoms.

NB – HRT is NOT the same as transgender hormone therapy, or cross sex hormone therapy, where sex hormones and other hormone medications are administered for transgender individuals.

Other resources:
https://www.menopausedoctor.co.uk/
https://thebms.org.uk/publications/consensus-statements/hormone-replacement-therapy/
https://www.nice.org.uk/guidance/ng23

Last reviewed: May 2021

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FAQs

What does HRT hormone do? ›

Hormone replacement therapy is medication that contains female hormones. You take the medication to replace the estrogen that your body stops making during menopause. Hormone therapy is most often used to treat common menopausal symptoms, including hot flashes and vaginal discomfort.

Is HRT the same as hormone therapy? ›

HRT (also known as hormone therapy, menopausal hormone therapy, and estrogen replacement therapy) is the most effective treatment for menopause symptoms. .

Why do doctors prescribe HRT? ›

Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of the menopause. It replaces the female hormones that are at a lower level as you experience the menopause. Oestrogen and progesterone are female hormones that play important roles in a woman's body.

Who is a good candidate for HRT? ›

Good candidates for hormone replacement therapy

Women who have gone through menopause at a younger age, perhaps before or in their mid-40s, can really benefit from HRT. The treatment protects their bones and cardiovascular system for what may very well be half of their life.

What are side effects of HRT? ›

These side effects will often pass after a few weeks.
...
Side effects of oestrogen
  • bloating.
  • breast tenderness or swelling.
  • swelling in other parts of the body.
  • feeling sick.
  • leg cramps.
  • headaches.
  • indigestion.
  • vaginal bleeding.

Does HRT make you gain weight? ›

There are many women out there who worry about weight gain being a side effect of taking HRT. However, several scientific studies show that there is no direct link between weight gain and the menopause itself.

Can I get HRT over the counter? ›

Before purchasing the treatment, women will have a consultation with a pharmacist. It will be available for women aged 50 and over who have not had a period in at least a year.

Does HRT make you look younger? ›

By supplementing your body's natural hormone levels, HRT can help you maintain a more youthful body composition. While this effect is particularly evident in men, research suggests that women can also benefit. HRT is also known to help women maintain softer, smoother skin, resulting in a younger look.

Can HRT cause hair loss? ›

Sometimes HRT may cause hair loss depending on the type taken. Doctors will sometimes prescribe HRT with testosterone to help improve their patients' libidos2. Unfortunately, testosterone can affect your hair follicles and cause androgenic alopecia.

How do you know when you need HRT? ›

You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first. A GP can explain the different types of HRT available and help you choose one that's suitable for you. You'll usually start with a low dose, which may be increased at a later stage.

Does every woman need HRT? ›

For women who experience premature or early menopause, HRT is strongly recommended until the average age of menopause (around 51 years), unless there is a particular reason for a woman not to take it.

What is the downside to HRT? ›

Combined HRT can be associated with a small increase in the risk of breast cancer. The increased risk is related to how long you take HRT, and it falls after you stop taking it. Because of the risk of breast cancer, it's especially important to attend all your breast cancer screening appointments if you're taking HRT.

How long after starting HRT Do you feel a difference? ›

It usually takes a few weeks before you feel the benefits of HRT. It can take up to 3 months to feel the full effects. If you have not felt the benefit of HRT after 4 to 6 months, it may help to try a different type. It can take your body time to get used to HRT.

Should a 70 year old woman take estrogen? ›

There is good news for older women age who are experiencing menopause symptoms like hot flashes and night sweats. You can safely get relief with hormone therapy (HT), according to the North American Menopause Society (NAMS).

Does HRT help with belly fat? ›

A new study of more than 1,000 postmenopausal women, ages 50 to 80, found that those who were currently taking hormones had significantly lower levels of tummy fat than women who had never used them.

What happens when you first start taking HRT? ›

When starting HRT, it's very common to experience some initial side effects or start-up symptoms such as breast tenderness or breast size increase. Some women describe slight nausea, headaches or abdominal bloating. Light erratic bleeding is also quite usual.

How does HRT make you feel? ›

Side Effects

Some women who use HRT say they feel bloated or have breast soreness. Nausea, dizziness, headaches, and blurry vision are also possible side effects, as is vaginal bleeding. If you haven't had a period for at least a year and have any bleeding or spotting, tell your doctor.

Does HRT change your body shape? ›

Your body will begin to redistribute your weight. Fat will collect around your hips and thighs and the muscles in your arms and legs will become less defined and have a smoother appearance as the fat just below your skin becomes a bit thicker.

Which HRT helps you lose weight? ›

Hormones that help with weight loss include: Testosterone: This sex hormone produced by both men and women inhibits fat storage, especially in the abdomen. Low levels cause sugar cravings and may lead to insulin resistance. Estrone: This form of estrogen helps women control their appetite and sugar cravings.

Does HRT help with sleep? ›

Hormone replacement therapy (HRT)

Systemic HRT can improve sleep quality, making it easier to get off to sleep, with less night-time waking; it has also been shown to improve chronic pain, mood and genitourinary symptoms. A 2017 study also demonstrated an improvement in hot flushes and night sweats.

Can you take HRT at 65? ›

HRT initiated before the age of 60 or within 10 years of the menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality. If HRT is to be used in women over 60 years of age, lower doses should be started, preferably with a transdermal route of estradiol administration.

Can you get HRT without seeing a doctor? ›

Right now, if you want to take any of the various forms of hormonal replacement therapy (HRT), you can only access the medication after a consultation with your GP or another specialist doctor.

How do I pay for HRT? ›

HRT provides many options for purchasing fares, including retail locations in Hampton Roads. All HRT vehicles, except light rail, are equipped with electronic fare boxes. Fare boxes accept cash, coins and GoPasses. Fare boxes and/or vehicle operators cannot make change, so please have exact fare when boarding.

What does HRT do to your face? ›

Hormone replacement therapy (HRT) has been shown to increase epidermal hydration, skin elasticity, skin thickness (Sator et al 2001), and also reduces skin wrinkles (Phillips et al 2001). Furthermore, the content and quality of collagen and the level of vascularization is enhanced (Brincat et al 1987).

Can I stay on HRT after 60? ›

Answer. Hormone therapy can be extremely beneficial for bone health purposes for women up to the age of 60 years, and in some circumstances women may continue hormone therapy after this age, depending on their general health, family history and bone density / history of fracture.

Is HRT good for your hair? ›

Estrogen and progesterone can help keep your hair in the growing (anagen) phase. Therefore, these hormones can help your hair stay on your head longer and may even help your hair grow faster. This may be why many women notice their hair thinning starts to improve with estrogen replacement therapy.

Does HRT cause facial hair growth? ›

Hormone Therapy: No, It will not Cause You To Grow Unwanted Hair and Here's Why. In today's youth-obsessed culture, the idea of taking hormone replacement therapy and growing unwanted hair is enough to keep many women away from this necessary treatment.

How can I thicken my menopausal hair? ›

Here are just some ways for you to reverse that problem, which usually affects the female population:
  1. #1 – Have a regular scalp massage.
  2. #2 – Improve your diet.
  3. #3 – Avoid excessive styling.
  4. #4 – Avoid stress.
  5. #5 – Take supplements.
  6. #6 – Use an anti-thinning shampoo.
  7. #7 – Try natural remedies for thinning hair.
27 Jan 2021

Will HRT help brain fog? ›

Benefits of HRT

The main benefit of HRT is that it can help relieve most menopause and perimenopause symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness.

What are the symptoms of low estrogen? ›

Signs of low estrogen include:
  • Dry skin.
  • Tender breasts.
  • Weak or brittle bones.
  • Trouble concentrating.
  • Moodiness and irritability.
  • Vaginal dryness or atrophy.
  • Hot flashes and night sweats.
  • Irregular periods or no periods (amenorrhea).
8 Feb 2022

Does HRT help with anxiety? ›

Hormone Replacement Therapy (HRT)

If your mood changes are related to the perimenopause and menopause, evidence indicates that HRT is better at improving your mood and anxiety than antidepressants. It may be worth a try, even for a short period of time, to see if it helps.

Can a 70 year old woman take HRT? ›

It is not usually appropriate for women over 60 to be starting HRT but as the WHI study shows, women initiating it over 60 years do not seem to be at increased risk of cardiovascular events or mortality. Many women seek advice on the effects of HRT on sexual activity and desire.

What is a natural form of HRT? ›

Complementary therapies

Several products are sold in health shops for treating menopausal symptoms, including herbal remedies such as evening primrose oil, black cohosh, angelica, ginseng and St John's wort.

Is it OK to go through menopause without HRT? ›

One of the common treatment options for menopausal symptoms is hormone replacement therapy (HRT), supplementing your hormone levels to rebalance your system. However, you may prefer to move through menopause without using hormone treatments. And, women with previous hormone-dependent cancer shouldn't use HRT.

How can I survive menopause without hormones? ›

Management of vasomotor menopausal symptoms with non-hormonal strategies
  1. Selective serotonin reuptake inhibitors and selective serotonin-norepinephrine reuptake inhibitors. ...
  2. Gabapentin and pregabalin. ...
  3. Clonidine. ...
  4. Purified pollen extract. ...
  5. Black cohosh.
11 Mar 2019

Does vitamin D increase estrogen? ›

High blood levels of vitamin D linked to reduced estrogen – and potentially lower breast cancer risk. Can taking daily vitamin D supplements decrease sex-hormone levels and thereby potentially reduce the risk of breast cancer in older women?

Does oatmeal increase estrogen? ›

Oats contain phytochemicals, including polyphenols and phytoestrogens. The polyphenols found in oats may help a man to experience an estrogen blocking effect. This would prevent their body from converting too many testosterone hormones into estrogen.

Do eggs increase estrogen? ›

Products like eggs or milk contain high estrogen levels because they are produced in parts of the animal's body that regulate its hormones. Eating high estrogen foods can help people who suffer from various conditions related to low estrogen levels.

What happens if a woman takes HRT? ›

HRT is used to treat menopausal symptoms. While HRT reduces the likelihood of some debilitating diseases such as osteoporosis, colorectal (bowel) cancer and heart disease, it may increase the chances of developing a blood clot (when given in tablet form) or breast cancer (when some types are used long-term).

Does HRT make you look younger? ›

By supplementing your body's natural hormone levels, HRT can help you maintain a more youthful body composition. While this effect is particularly evident in men, research suggests that women can also benefit. HRT is also known to help women maintain softer, smoother skin, resulting in a younger look.

Does HRT reduce weight? ›

Hormone replacement therapy (HRT) can affect weight loss in women. In addition to having less abdominal fat, the same study found that women undergoing HRT were almost one whole point lower on the body mass index (BMI) scale, and they had nearly 3 pounds less of fat mass.

How long after starting HRT Do you feel a difference? ›

It usually takes a few weeks before you feel the benefits of HRT. It can take up to 3 months to feel the full effects. If you have not felt the benefit of HRT after 4 to 6 months, it may help to try a different type. It can take your body time to get used to HRT.

Is 58 too old for HRT? ›

Answer. Hormone therapy can be extremely beneficial for bone health purposes for women up to the age of 60 years, and in some circumstances women may continue hormone therapy after this age, depending on their general health, family history and bone density / history of fracture.

Can you stay on HRT for life? ›

There's no limit on how long you can take HRT, but talk to a GP about how long they recommend you take the treatment. Most women stop taking it once their menopausal symptoms pass, which is usually after a few years.

Does HRT help with belly fat? ›

A new study of more than 1,000 postmenopausal women, ages 50 to 80, found that those who were currently taking hormones had significantly lower levels of tummy fat than women who had never used them.

Does HRT affect hair? ›

HRT and Hair Regrowth

Estrogen and progesterone are hormones that aid in healthy hair growth, so when your body stops producing these, it can cause hair loss. Taking HRT can help prevent this loss and may even help regrow hair. In fact, some trans women with androgen alopecia who underwent HRT saw hair regrowth3.

What does HRT do to your face? ›

Hormone replacement therapy (HRT) has been shown to increase epidermal hydration, skin elasticity, skin thickness (Sator et al 2001), and also reduces skin wrinkles (Phillips et al 2001). Furthermore, the content and quality of collagen and the level of vascularization is enhanced (Brincat et al 1987).

Will HRT help with tiredness? ›

Some women find that Hormone Replacement Therapy (HRT) helps with their fatigue. HRT is an effective way of managing menopause symptoms and can improve the overall quality of your life, energy levels and sleep.

How does HRT make you feel? ›

Side Effects

Some women who use HRT say they feel bloated or have breast soreness. Nausea, dizziness, headaches, and blurry vision are also possible side effects, as is vaginal bleeding. If you haven't had a period for at least a year and have any bleeding or spotting, tell your doctor.

Does HRT speed up your metabolism? ›

Likewise, HRT regulates metabolism, which means the body burns more calories and appetite is reduced. HRT can also help to reduce the risk of obesity-related diseases, such as heart disease and type II diabetes. Additional benefits include reduced hot flashes and night sweats, increased bone density, and improved mood.

Can I go back on HRT at 65? ›

It is not usually appropriate for women over 60 to be starting HRT but as the WHI study shows, women initiating it over 60 years do not seem to be at increased risk of cardiovascular events or mortality.

What happens when you first start taking HRT? ›

When starting HRT, it's very common to experience some initial side effects or start-up symptoms such as breast tenderness or breast size increase. Some women describe slight nausea, headaches or abdominal bloating. Light erratic bleeding is also quite usual.

Why do I feel awful on HRT? ›

Estrogen can give side effects of headache, breast tenderness and mild nausea. These tend to be common when you first start hormone replacement or increase the dose but often settle after a few weeks.

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