HRT - Hormone Replacement Therapy/ MRT - Menopause Hormone Therapy

In this section, you will find more detailed information about Hormone Replacement Therapy (HRT) and other medical hormonal and non-hormonal treatments for symptoms. 

Before we start, however, please note that statistics may vary depending on the country you reside in.

Now, let’s discuss HRT. 

Menopausal symptoms can be managed medically by prescribing hormones that replace your body’s declining estrogen levels. This is known as Hormone Replacement Therapy (HRT).

The Benefits of HRT

HRT can effectively manage various menopausal symptoms and offers several benefits:

• Relief from short-term symptoms like hot flashes, night sweats, vaginal atrophy, mood swings, cognitive issues, and insomnia

• Protection against long-term risks, such as heart disease and osteoporosis. Studies show that HRT can continue to benefit bone health even after discontinuation.

• Potential protective effects against Alzheimer’s, although more research is required

• Improved quality of life and wellbeing

• No arbitrary limits on the duration of treatment

• It is essential to understand that the decision to start HRT is personal and should be discussed with a healthcare professional. Regular check-ups and reviews with your doctor are also crucial during HRT treatment.

HRT is not a one-size-fits-all solution, and its efficacy may vary from person to person. Alongside HRT, you can explore non-hormonal treatments and make dietary and lifestyle changes to manage menopause symptoms effectively.

HRT Regimens  

There are over 50 different combinations of HRT. These can be divided into two groups:

• Estrogen-only therapy: Suitable for individuals without a uterus or womb

• Estrogen and progesterone therapy (combined therapy): Necessary for individuals with a uterus, as estrogen alone can stimulate the endometrial lining of the uterus, requiring progesterone to maintain uterine health.

Combined HRT can be taken on a cyclical basis or continuously, depending on the menopausal phase:

• Cyclical HRT: Recommended for perimenopausal individuals experiencing menopausal symptoms years before their periods stop. It usually involves continuous estrogen intake with progesterone added from days 12 to 22 of the cycle, mimicking a natural menstrual cycle with a bleed.

• Continuous HRT: Recommended for postmenopausal individuals, involving continuous intake of both estrogen and progesterone without a bleed.

Dosages may vary, and younger individuals or those with surgical menopause may require higher HRT doses. By around the age of 54, approximately 80% of people have usually stopped menstruating, making it an appropriate time to switch from cyclical to continuous HRT.

Recent research suggests that the best time to start HRT is around 18 months before or after periods stop when the endothelium (part of the womb lining) remains active and responsive to HRT.

Vaginal estrogen may be effective for treating symptoms of vaginal atrophy and can be used with or without systemic HRT. It is available as pessaries or creams.

How to take HRT

There are a variety of ways to take HRT. Options for different routes of both estrogen and progesterone include:

• Oral tablets – the most cost-effective but also has the most side effects as the medication has to be metabolized in the liver

• Transdermal – delivered through the skin via gel or patch

• Intrauterine device – like the Mirena Coil, but delivers progesterone-only

• Vaginal – also delivers progesterone-only

• Subcutaneous – delivered via implants

Although combined HRT comprises both estrogen and progesterone, the estrogen and progesterone can be delivered separately.

There are different options when it comes to progesterone.  It can be delivered orally in the form of tablets—as a pessary—or in the form of an intrauterine device known as a Mirena Coil. So you could have an estrogen gel or patch in combination with a Mirena Coil, for example. Different combinations work better for different people.

It is also important to remember that HRT is not a contraceptive. The commercially available progesterone creams DO NOT offer sufficient protection for the womb lining.

There is no one-size-fits-all in HRT. Some methods of administration work for some individuals, while others don’t.

You may need to try different brands or HRT regimens before finding the right combination that works for you. Finding the right HRT for your particular metabolism is the key. Give each brand or type 3-6 months to take effect.