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HRT QUESTIONS YOU FORGOT TO ASK YOUR GP

How many times have you returned home after a doctor’s appointment and thought of several things that you forgot to ask? In this article, we look at some of the common questions that women considering HRT raise in a consultation.

This article was included in issue 72 (spring 2017) of The Menopause Exchange newsletter.

How soon will HRT work?
HRT should start helping to control your symptoms within a week, especially if you have severe symptoms, including hot flushes and night sweats, before starting HRT. Your follow up review is the time when decisions on any dose adjustments or a change in the way you take HRT are made if you’re getting some, but not complete, symptom control.

What problems may occur when I start HRT?
When you start taking HRT, the level of female hormones increases in your body. Using combined HRT means that you’re taking both oestrogen and progesterone/progestogen. In the settling in phase, you can expect some breast tenderness, maybe even an increase in breast size and bleeding incidences. These initial side effects should settle within three to four months. If you’re prescribed a monthly bleed type of HRT, you may notice some breakthrough bleeding. If so, you would be advised to keep a diary so that your doctor can decide whether this is due to the settling in phase or whether there’s a need to investigate further. If you start on ‘no bleed’ HRT, you’ll be asked to keep a bleed diary as it can sometimes take up to six months to settle and become totally bleed free. Very rarely, some women develop high blood pressure within the first three months of starting HRT. Other potential side effects will be discussed in relation to your medical history, to give you personalised advice. For example, a woman who is a migraine sufferer or has progestogen sensitivity will be advised to report any worsening symptoms once she starts HRT.

Will using HRT make me look younger?
HRT hasn’t been researched for its effects on ‘looks’ or ‘appearance’, but there’s much interest in this area. Some research suggests that oestrogen can help with collagen protection, skin thickness and elasticity, but there’s a need for more research to understand the impact of oestrogen on skin quality. Oestrogen also helps to maintain bone mineral density and to reduce the risk of fragility fractures in women. What’s important to remember is that HRT definitely helps with symptom control, and will therefore help to improve your quality of life, particularly if you’re struggling with hot flushes and night sweats, low moods or sleep problems during the menopause. With life again on an even keel with HRT use, you may be more motivated to exercise and eat healthily, to socialise and be more active, and even stop smoking and reduce your alcohol intake. These lifestyle interventions can help to slow down the ageing process, including keeping your bones strong.

Will HRT improve my sex life?
If the menopause affects your sex life, HRT will help, as it improves symptoms such as vaginal atrophy (dryness), dyspareunia (painful sex), bladder symptoms (such as urinary tract infections) and a loss of libido. HRT can be prescribed in various ways, including vaginal formulations used for localised symptom control.

What should I do if I forget to take a tablet?
Take the next due tablet and get back into the advised routine for taking your HRT. Keep a diary of any bleed incidents so you can let your doctor know at your next review. However if you have continuous bleeding, you should make an appointment with your doctor for a review straight away.

Can I get pregnant on HRT?
HRT doesn’t provide contraception so you can get pregnant while you’re on it, although the chances of this are very low after the age of 50. National guidance for contraception recommends that if you’re naturally bleed free for a year after 50, you don’t need any additional contraception. If you’re on HRT and it’s difficult to work out whether you’ve been naturally bleed free for a year, you should use barrier contraception, such as condoms until you’re 54. A progestogen-only pill can be used with HRT to provide effective contraception, but the HRT must include progestogen as well as oestrogen.

Will using an oestrogen gel irritate my skin?
Generally women use oestrogen gel preparations without any skin irritation. However, if you have a skin condition, or are allergic to certain chemicals, you shouldn’t use that particular formulation again. The patient information leaflet provided with the product will list all the chemicals used in that formulation.

Will the patch fall off when I bathe, shower or swim?
HRT patches are formulated with a good adhesive, so they should stick properly and not fall off if you follow the advice on how to put the patches on. For example, patches are applied to a dry area of your skin, without using moisturiser on that area just beforehand. You should change the application site each time you apply a new patch. Another rare reason for patches falling off is because your skin may be naturally oily. In this case, another way of using HRT may need to be considered.

Will I feel better on HRT?
NICE (National Institute for Health and Care Excellence) has published guidance on the use of HRT after the menopause. This highlights the following symptoms, where there’s good research evidence for the use of HRT: vasomotor symptoms, such as hot flushes and night sweats, vaginal atrophy (dryness), bladder symptoms, low mood and reduced sex drive after the menopause. If these are some of your symptoms and they have been present after the menopause, HRT should make you feel better.

About the author
Dr Nuttan Tanna is a pharmacist consultant at The Northwick Park Menopause Clinical & Research Unit at London North West Healthcare NHS Trust, Harrow, Middlesex.

References:

  1. Mattsson LÅ, Ipsen HEGranqvist CJKokot-Kierepa MStudy Group. Ultra-low-dose estradiol and norethisterone acetate: bleeding patterns and other outcomes over 52 weeks of therapy. Climacteric. 2015 Jun;18(3):419-25. doi: 10.3109/13697137.2014.999661. Epub 2015 Feb 12.
  2. Faculty of Sexual & Reproductive Healthcare Clinical Guidance. Contraception for Women Aged Over 40 Years Clinical Effectiveness Unit July 2010. ISSN 1755-103X http://www.fsrh.org/documents/cec-ceu-guidance-womenover40-jul-2010/
  3. NICE guideline [NG23]. Menopause: diagnosis and management. Published date: November 2015. https://www.nice.org.uk/guidance/ng23

Created spring 2017

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