How does hormone replacement therapy work

Different types of hormone replacement therapy (HRT) areavailable.

If you're considering HRT, talk to your GP about the options suitable foryou, as well as possible alternatives to HRT .

This pagecovers the different:

HRThormones

Ways you can take HRT

HRT treatment regimens

HRT hormones

HRTreplaces thehormones that a woman's body no longer produces because of the Testosterone deficiency (hypogonadism) .

The two mainhormones used in HRT are:

• oestrogen types used includeestradiol, estrone and estriol
• progestogena man-made version of the hormoneprogesterone, such asdydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel

HRT involves either taking both of these hormones (combined HRT) or just taking oestrogen (oestrogen-only HRT).

Most women takecombined HRT because taking oestrogen on its own can increase your risk of developing womb (endometrial) cancer . Taking progestogen alongsideoestrogen minimises this risk.

Oestrogen-only HRT is usually onlyrecommended for women who have had their womb removed during a hysterectomy .

Ways of taking HRT

HRT is available in several preparations that are taken in different ways. Talk to your GP about the pros and cons of each option.

The mainforms of HRTare outlined below.

Tablets

Tablets, which are usually taken once a day, are one of the most common ways of taking HRT.

Oestrogen-only and combined HRT tablets are available. For some women this may be the simplest way ofhavingtreatment.

However,it's important to be aware that some of the risks of HRT , such as blood clots , are higher with tablets than with other forms of HRT (although the overall risk is still small).

Skin patches

Skin patches are also a common way of taking HRT. You stick them to your skin and replace them every few days. Oestrogen-only and combined HRTpatches are available.

Patchesmay be a better option than tablets if you think you might find it inconvenientto take a tablet every day.

Using patches can also help avoid some side effects of HRT , such as indigestion , and unlike tablets they don'tincrease yourrisk of blood clots.

Oestrogen gel

Oestrogen gel is an increasinglypopular form of HRT. It's applied to the skin once a day and is absorbed by the body.

Like skin patches, this can be a convenient way of taking HRT while avoiding an increased risk ofblood clots.

Butif you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.

Implants

HRT can be given using small pellet-like implants inserted underyour skin (usually in thetummy area) while your skin is numbed with local anaesthetic , although these aren't widely available and aren't used very often.

The implantsrelease oestrogen gradually over time and can stay in place for several months before needing to be replaced.

This may be a convenient option if you don't want to worry about taking your treatment every day or every few days. But if you still have your womb, you'll need to take progestogen separately too.

If you're taking a different form of oestrogen and need to take progestogen alongside it,another implant option is the intrauterine system (IUS) . An IUS releasesa progestogen hormone into the womb.It can remain in place for a few years and also acts as a contraceptive.

Vaginal oestrogen

Oestrogen is also available in the form of a cream, pessary or ring that is placed inside your vagina.

This can help relieve vaginal dryness , but won't help with other symptoms such as hot flushes.

It doesn't carry the usual risks of HRT and can be used without taking progestogen even if you still have a womb.

HRT treatment regimens

Different treatment courses of HRT are also available, depending on whether you're still in the early stages of the menopause or have had menopausal symptoms for some time.

The two types are cyclical (or sequential) HRT and continuous HRT .

Cyclical HRT

Cyclical HRT, also known as sequential HRT, is often recommended for women taking combined HRT whohave menopausal symptoms but still have their periods .

There are two types of cyclical HRT:

• monthly HRT you take oestrogen every day, and take progestogen alongside it for the last 14 daysof your menstrual cycle
• three-monthly HRT you take oestrogen every day, and take progestogen alongside it for around 14 days every three months

Monthly HRT is usually recommended for women having regular periods.

Three-monthly HRT is usually recommended for women experiencing irregular periods . You shouldhavea period every three months.

It's useful to maintain regular periods so you know when your periods naturally stop and when you're likely to progress to the last stage of the menopause.

Continuous combined HRT

Continuous combined HRT is usually recommended for women who are post-menopausal. A woman is usually saidtobe post-menopausal if she has not had a period for a year.

As the name suggests, continuous HRT involves taking oestrogen and progestogen every day without a break.

Oestrogen-only HRT is also usually taken continuously.