The Menopause and HRT - A Summary

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What is the menopause and what are the symptoms?

Strictly speaking, the menopause is the last period. However, most women think of the menopause as the time leading up to, and after, their last period. It occurs because the ovaries make less oestrogen (the main female hormone) as you get older. The average age of the menopause is 51.

You may have no problems. However, it is common to develop recurring hot flushes for 2-3 years. In time, the skin and vulva (skin next to the vagina) may become drier, thinner, and more likely to itch. Your vagina may shrink a little, and expand less easily during sex. You may then have some pain when you have sex.

Other symptoms may develop such as headaches, tiredness, palpitations, being irritable, sleep problems, depression, anxiety, aches, loss of sex drive. It can be difficult to say whether these are due to the hormone changes of the menopause. You may sleep badly, become anxious, irritable, etc, because you have frequent hot flushes, and not directly because of a low oestrogen level.

What is HRT (hormone replacement therapy)?

HRT contains oestrogen which replaces the oestrogen that your ovaries no longer make. HRT comes as tablets, skin-patches, gels, nasal spray, cream, or skin implants. If you have not had a hysterectomy, the oestrogen is combined with a progestogen hormone which protects you from an increased risk of cancer of the uterus, (a risk if you just take oestrogen alone.)

What are the benefits and risks of HRT?

• Benefits. HRT usually stops hot flushes. It can reverse the changes around the vagina. If you are irritable because of menopausal symptoms, you may feel generally better as menopausal symptoms improve. If you take HRT for several years, it helps to protect against osteoporosis (bones that become more fragile which can break easily) and bowel cancer.
• Risks. HRT causes a slight increase in the risk of developing: a serious blood clot (thrombosis), breast cancer, stroke, heart attack, ovarian cancer, and possibly dementia.

How long is HRT taken for?

To ease menopausal symptoms, you may be happy to accept the small risk of taking HRT for 1-3 years. After 1-3 years the worst of the flushing-type symptoms have often gone and HRT is no longer needed. If the genital symptoms such as vaginal dryness persist after stopping HRT, an option is to use an oestrogen cream or pessary in the vaginal area.

A few years ago HRT was widely used to prevent osteoporosis. However, research has shown that there are potential serious health risks with taking HRT (described above). So, HRT is not used to prevent osteoporosis for most women. However, if you have an early menopause, HRT may be advised until you are aged 50. You have an increased risk of developing osteoporosis if you have an early menopause. The health risks of taking HRT are not thought to apply, or be very small, until you reach the usual age of menopause (about aged 50).

© EMIS and PIP 2006   Updated: May 2006   PRODIGY Validated