Menopause indicates an end to menstruation for a woman. The woman no longer releases a mature egg (ovulation), and her ovaries stop producing the female sex hormone estrogen. Menopause is a natural event that signifies the end of reproductive years.

Unfortunately, many women experience unpleasant symptoms before and after menopause. These symptoms include vaginal dryness, sleep disturbance, night sweats, and hot flushes. You can manage menopause symptoms and physical changes through various ways, including increased exercise, healthier eating, and hormone replacement therapy (HRT).

What is Hormone Replacement Therapy?

Hormone therapy or menopausal hormone therapy is a medication that contains the hormones that the woman’s body is no longer producing due to menopause. You take this medication to give you estrogen that your body is not making. HRT treats menopausal symptoms, such as vaginal discomfort and hot flushes.

Apart from dealing with menopause symptoms, hormone therapy has also been effective in preventing bone loss and reducing fractures in postmenopausal women.

However, hormone therapy has some risks. The risks depend on the individual’s health risks, type of HRT, the dose, and how long you take the medication. To obtain the best outcomes, hormone therapy should be customized to each individual and regularly reevaluated to ensure that the benefits are greater than the risks.

Basic Types of Hormone Therapy

HRT mainly focuses on replacing the estrogen that is no longer produced by your body after menopause. Estrogen therapy comes in two main types:

  • Systemic hormone therapy: This is systemic estrogen available in spray, cream, gel, ring, skin patch or pill form. It contains a higher estrogen dose absorbed all over the body. It is used to treat all common menopause symptoms.
  • Low-dose vaginal products: These are low-dose estrogen vaginal preparations, which are available in the ring, tablet, or cream form. They reduce the amount of estrogen that the body absorbs. Due to this, low-dose vaginal preparations only treat menopause urinary and vaginal symptoms.

If you still have your uterus, your doctor should prescribe estrogen combined with progestin. If estrogen is not balanced with progestin or progesterone, it can promote the growth of the uterine lining, which makes you prone to endometrial cancer. If you have undergone a hysterectomy (removal of the uterus), you may not be required to take progestin.

Benefits of Hormone Therapy

The benefits of hormone therapy are greater than the risks for most women under 60 years. They include:

  • Reduction in Menopause Symptoms

HRT is the most efficient treatment in reducing symptoms of menopause. These symptoms usually improve within four weeks of the treatment, and maximum benefits are seen by the third month. For example, there is evidence to show a significant reduction in hot flushes by about 18 a week.

  • Improves Life Quality

Hormone therapy also improves sleep, muscle pains and aches, and quality of life in menopausal women. It can also improve mood and depressive symptoms. You can have HRT treatment to eliminate the low mood associated with menopause.

  • Improves Urogenital Symptoms

Several studies have shown that hormonal therapy improves sexual function and vaginal dryness caused by menopause. HRT is effective in reducing symptoms associated with vaginal atrophy. It can also relieve symptoms of urinary frequency because of its effect on the urethral epithelium and the bladder. Topical estrogen, a type of HRT, improves urinary symptoms during menopause.

  • Reduced Risk of Osteoporosis

Estrogens increase bone mineral density and prevent osteoporotic fractures in women. Hormone therapy is the initial treatment provided to manage and prevent osteoporosis in women experiencing menopausal symptoms aged below 50 years, as it has been shown to be very effective. HRT should be the first-choice treatment for women prone to fractures if there are no HRT contra-indications.

The bone protection effects of HRT are related to the dose administered. But even low estrogen doses provide some protection. Hormone replacement therapy normalizes turnover and preserves bone mineral density at all skeletal sites, which leads to a significant reduction in fractures.

Although bone density reduces after discontinuation of hormone therapy, studies show that women who take the treatment for a few years during menopause experience long-term protection long after stopping HRT.

  • Reduces Cardiovascular Disease

Taking hormone therapy can reduce your risk of cardiovascular disease. HRT has been seen to minimize coronary heart disease incidences by about 50% if you start it within ten years of menopause. Usually, estrogens have positive effects by lowering LDL-cholesterol levels and raising HDL-cholesterol levels. On the other hand, progestogens have opposite effects of estrogen or neutral, which depends on the dosage. Therefore, if you take HRT before you reach 60 years, you will have reduced risks of cardiovascular disease.

How to Start Hormone Therapy

If you want to start hormone therapy, talk to a healthcare professional. Usually, you can begin HRT as soon as you have the initial menopausal symptoms, and you will not require any tests initially. Your GP will explain the different HRT types available and help choose the most suitable one for you.

Typically, it would help if you began with a low dose, which should be increased later on. Initially, you may experience some side effects, and the treatment may need a few weeks to be effective. Your doctor will recommend having a three-month trial to see the results of the treatment. If the initial dose does not work, they may increase it or change the hormone therapy type you are taking.

Who is Eligible for HRT?

Most women experiencing symptoms related to menopause can have HRT. However, you should not take the treatment if you:

  • Are pregnant. It is still possible to conceive while on hormone therapy. So, you should still use contraception until two years after your last period if you are below 50 years old.
  • Have a history of ovarian cancer, breast cancer, womb cancer, or blood clots
  • Have liver disease
  • Have unmanaged high blood pressure. It would help if you first controlled your blood pressure before starting HRT.

If you are in any of these situations, your doctor will recommend alternatives to hormone therapy.

Stopping Hormone Therapy

There is no set timeline to stop HRT. However, you can discuss when you should stop the treatment with your doctor. Most women take HRT until their menopausal symptoms pass, generally after a few years. However, you should be aware that taking HRT for more than one year slightly increases your risk of breast cancer. This risk is present in all HRT types except vaginal estrogen.

Your risk of having breast cancer reduces when you stop HRT, but you will still be at risk for ten years compared to someone who never had HRT. Stopping HRT can be gradual or sudden, but a gradual decrease of the HRT dose is recommended to reduce the chances of your symptoms returning in the short term. Contact your doctor if your symptoms continue for several months after stopping HRT or if the symptoms become severe. Then, you may be required to restart HRT.