A B O U T   Y O U R   M E D I C I N E

Numerous brands of this type of medicine are available and in a variety of forms (tablets, patches, gel) but essentially HRT can be classified into three basic types. These are:

Preparations which contain oestrogen-only and including:

Preparations which contain an oestrogen plus sequential progestogen and including:

Preparations which contain an oestrogen plus continuous combined progestogen and including:

Hormone replacement therapy or HRT, as the name suggests, is a means of continuing to provide oestrogen (the female sex hormone) after its production by the ovaries has started to fail at the menopause or "change of life" when normal periods have ceased. HRT is prescribed at this time in order to sustain those body functions which are dependent on oestrogen and to relieve troublesome symptoms such as hot flushes and sweating. Other problems which are relived by HRT include vaginal irritation and dryness and urinary frequency or incontinence. In long term use, HRT protects against osteoporosis (thin bones) and resulting bone fractures and is also believed to reduce the risk of heart attacks and strokes. HRT is also be required for younger women who have an "early" menopause associated with concurrent illness or surgical removal of their ovaries.

There is currently a bewildering range of HRT products available, see above. However these can be divided into three basic types.

Preparations which contain oestrogen-only are appropriate for women who have undergone a prior hysterectomy (surgical removal of the womb). If however the womb (or uterus) is intact, it is necessary to give a second hormone in addition to oestrogen called a progestogen. Progestogens prevent the tendency for oestrogens to cause the uterus to enlarge which in turn is thought to be associated with a slightly increased risk of cancer of the womb.

Preparations which contain an oestrogen plus sequential progestogen are favoured for women around the time of the menopause. They are intended to produce a "more natural" cycle of oestrogen and progestogen production and so predicatably they will cause bleeding similar to a regular period. This may not be acceptable for older women for whom preparations which contain an oestrogen plus continuous combined progestogen may be preferred. The latter are often used for women who have not had a "natural" period for at least one year. A switch from sequential to continuous combined HRT is usually possible after 1-2 years or after the age of 54 years.

HRT can be taken as tablets by mouth on a cyclical or continuous basis or applied to the skin every 3-4 days in the form of adhesive patches from which the medicine is gradually released, or if oestrogen-only is appropriate, as a gel which is massaged into the skin. Given the huge range of products that is available it is usually possible to find one that will suit most people and this is the basis on which they are chosen. It is not possible to describe each product in detail here but all are accompanied with easy to follow instructions and the package insert should always be consulted when commencing HRT. If in doubt, seek advice from your Pharmacist.

This has been a very controversial issue ever since the use of HRT became widespread. Although it is accepted that HRT does increases the risk of blood clots forming in the veins compared with non-users of HRT, it is estimated that this is likely to account for only 1 extra case per year of deep vein thrombosis for every 5,000 HRT users. Clearly other factors which increase the risk of blood clots such as obesity, immobility and smoking must also be taken into account when assessing the overall risk. If there has previously been a case of thrombosis this will be of concern but there is no evidence that the presence of varicose veins (which are very common) should prevent anyone taking HRT.

The risk of deep vein thrombosis and therefore blood clots on the lung has been the subject of recent research where the combined oestrogen/progesterone HRT pill was associated with an extra 8 serious blood clots for every 10,000 women treated for 5 years.

Withdrawal bleeding apart (which occurs with sequential combined products, see above), there may be unexpected bleeding or spotting when other HRT preparations are first used. Only occasionally does this persist or is seen as a problem in which case an alternative HRT product can be tried. In any event your Doctor should be informed so that he or she can investigate further, if necessary. It is a good idea to keep a diary of such events so that your Doctor can assess the problem from time to time.

This has received a great deal of publicity in the media in the past and women are understandably concerned given the incidence of breast cancer in the United Kingdom. Large studies which have been undertaken in an attempt to assess the risk of breast cancer in women who take HRT have failed to confirm anything other than a slightly increased risk after 5 or more years of continuous use. The risk would appear to be an extra 8  women develop breast cancer out of 10,000 when treated with the combined pill for 5 years. There is therefore a need for regular breast screening including self-examination of the breasts for the appearance of lumps. However breast lumps are much more common than breast cancers and your doctor will frequently be able to re-assure you should you find them. You should pay special attention to regular breast checks if you have had problems with breast lumps in the past.

Although the risk of breast cancer continues to receive a great deal of publicity in the press and on television, what is often overlooked is the considerable benefits that HRT brings in relation to reducing the risk of heart attacks and strokes.

This is not uncommon in users of HRT and will often go unnoticed. It is not an indication of any underlying problem but if you have kidney or heart problems or suffer from high blood pressure, your doctor may wish to keep a close check on these conditions from time to time.

Recent evidence suggests that HRT does not prevent heart disease and may actually increase the risk in the first year of use. In the 5 year study of treatment of 10,000 women with the combined HRT pill an extra 7 women developed heart disease than would be expected for their age, an extra 8 had a stroke BUT 6 fewer developed colorectal cancer a 5 fewer suffered a hip fracture.

Stomach upsets including nausea, vomiting, abdominal pain and liver problems have been encountered and may be a reason for switching from tablets to patches. Breast tenderness or breast engorgement may also occur. Skin conditions may occur or deteriorate if already present.

It is stated in Patient Information Leaflets which accompany HRT products that conditions such as multiple sclerosis, systemic lupus erythematosus, porphyria, melanoma, epilepsy, migraine and asthma may worsen on HRT. Some of these conditions are rare but if you suffer from them you will be all too aware of what they are. The important point is to recognise that HRT is a replacement for oestrogen which is a natural hormone anyway and there is no known reason why such conditions should get worse. Do not therefore assume that your condition will be affected but do consult your Doctor if you believe that this has happened. It may be necessary to discontinue treatment in some cases.

An adjustment of anti-diabetic medication may be required when HRT is commenced. Occasionally a change in glucose tolerance (your diabetes control) may occur.

It is likely that if you have fibroids in your womb or endometriosis that HRT will cause further problems. Seek medical advice if you are uncertain about this.

The effectiveness of HRT in tablet form may be reduced by concurrent use of some anti-epileptic medicines including barbiturates, phenytoin (EpanutinÒ ) and carbamazepine (TegretolÒ ) all of which may increase its metabolism (breakdown) by the liver. Your Doctor or Pharmacist can advise you.

HRT preparations should be kept in the packs in which they are supplied i.e. tablets in blister calender packs, patches in individual sachets. The dosing instructions are set out in detail for combined (oestrogen plus progestogen) preparations. If you forget to take your tablets on any one day, ignore these and continue your treatment according to the calender pack on the following day. All products are stored at room temperature.

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Ó NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.