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Hormone replacement therapy (HRT) can contain oestrogen, progesterone and testosterone. These hormones reduce menopausal symptoms and also offer benefits for bone protection, cardiovascular health and cognitive function. For most women, HRT benefits far outweigh any potential risks of blood clotting, stroke or breast cancer. Every woman’s experience of menopause and/or HRT treatment is unique, so the management approach is very individual. You may have questions about whether HRT is right for you, and how to use it.

This article was included in issue 86 (autumn 2020) of The Menopause Exchange newsletter.

Will HRT help my brain fog?
HRT certainly helps with brain fog. The main female hormones play an important role in memory and cognitive function. Women who suffer from poor memory and difficulties around multitasking or retaining information during the perimenopause or menopause often report their symptoms get better after starting HRT. Although there’s a lack of robust clinical evidence and further studies are needed, it appears that starting oestrogen replacement in the perimenopause or early menopause may offer some protection against the risk of developing Alzheimer’s and dementia.

How soon will HRT work?
It usually takes a few weeks to feel the initial benefits of HRT, and up to three months to feel the full effects. Some women who are sensitive to hormone changes may notice benefits within one or two days while others may need four to six weeks to notice significant changes in their symptoms. It’s common to experience some minor side effects, such as headaches, breast tenderness, nausea and irregular bleeding, in the first one or two months of starting HRT. These side effects usually settle by three months.

What should I do if I forget to take my HRT?
Generally, if you miss one or two doses, you should just take the next dose on time. Interrupting your treatment may make your symptoms come back and lead to an episode of irregular bleeding. If you’re taking HRT pills and you miss a dose, take the next one as soon as possible. But if it’s almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Don’t take double doses. If you forget to apply a new skin patch when you’re supposed to, apply it as soon as possible. Then go back to replacing the patch on the same day of the week as before. Don’t apply more than one patch at a time.

Can I get pregnant on HRT?
HRT isn’t a contraceptive and doesn’t significantly stop your ovaries from working. So it’s still possible to get pregnant while using it. You should use contraception until two years after your last period if you’re under 50, or for one year after the age of 50. Women with premature menopause have the option of using the combined contraceptive pill as a form of oestrogen replacement/HRT while getting the benefit of contraception at the same time. In fact, most national guidelines recommend that women who wish to avoid unwanted pregnancy while on HRT should keep using some form of contraception until age 55 when a loss of natural fertility can be assumed.

Will an oestrogen gel irritate my skin?
Oestrogen gel is easy to use, well tolerated and doesn’t usually cause skin reactions in most women. But, like any other medicine, this depends on how sensitive your skin is, and some women have reported rashes or allergic reactions after using oestrogen gel. Oestrogen gel appears to cause fewer skin reactions than oestrogen patches.

It’s important to apply the gel to clean, dry, and unbroken skin. Spread it as thinly as possible over the entire area on the inside and outside of your upper arms and shoulder area or your thighs. Don’t apply the gel directly to your breasts or in or around your vagina. It’s important that other people don’t come into contact with the area of skin where you applied the gel for at least one hour after using the gel, and that you allow the gel to dry for at least 15 minutes before you get dressed.

Will an HRT patch fall off when I bathe, shower or swim?
You can have a bath, shower or swim while you’re using HRT patches. This won’t generally affect the patch in most women. But occasionally you may find that a patch falls off. If this happens, reapply the patch on a different area of your skin. If it doesn’t stick completely, you can put on a new patch, but it’s important to keep following your original schedule for changing your patch.

Will I put on weight on HRT?
There’s no evidence to support a direct link between HRT and weight gain. You may gain weight in your middle years due to changes in your diet, physical activity and other aspects of your lifestyle. A slowing metabolic rate and redistribution of your body fat may also contribute to this. Eating a healthy diet and taking regular exercise are important to prevent weight gain. Some women experience side effects of bloating and fluid retention on HRT, which can lead them to believe they’re putting on weight.

Will I feel better on HRT?
HRT is the most effective treatment for menopausal symptoms, as it replaces oestrogen in your body. Taking the right type and dose of oestrogen can help to improve low mood, tiredness, low libido, brain fogging, joint aches, vaginal dryness and sleep problems, as well as other symptoms related to the menopause. Many women find they feel calmer, have more energy, are more motivated and generally feel happier when they take HRT.

Will HRT improve my sex life?
HRT can boost your sexual interest. Replacing oestrogen and progesterone may improve your libido and reduce vaginal dryness, while testosterone plays an important role in sexual arousal, sexual response, libido, reducing vaginal dryness, energy levels and wellbeing in women.

About the author
Dr Vikram Talaulikar is Associate Specialist in Reproductive Medicine and Menopause Specialist at University College London Hospital.

Created Autumn 2020 

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