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Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is a medical treatment that boosts declining levels of oestrogen and progesterone in a person approaching menopause.

Hormone Replacement Therapy (HRT): What You Need to Know

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Hormone Replacement Therapy (HRT) is a medical treatment that boosts declining levels of oestrogen and progesterone in a person approaching menopause. It helps ease some menopausal symptoms, such as hot flashes, night sweats, and vaginal dryness. HRT can be used orally, topically, or vaginally.

In this article, we will explore the benefits and risks of HRT, the different types of HRT available, and how to decide if HRT is right for you.

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Benefits of HRT

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HRT can provide relief from moderate to severe menopausal symptoms that affect your quality of life. Some of the benefits of HRT are:

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Reducing the frequency and intensity of hot flashes and night sweats, which are caused by fluctuations in oestrogen levels.
Improving vaginal health by preventing dryness, thinning, and inflammation of the vaginal tissues, which can lead to discomfort, pain, and infections.
Preventing bone loss and reducing the risk of osteoporosis and fractures, which are more common after menopause due to lower oestrogen levels.
Lowering the risk of heart disease and stroke in younger women (under 60) who start HRT soon after menopause, as oestrogen has a protective effect on the blood vessels and cholesterol levels.

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Risks of HRT

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HRT is not without risks, and some women may not be suitable candidates for this treatment. Some of the risks of HRT are:

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Increasing the risk of breast cancer, especially with long-term use (more than five years) of combined oestrogen-progestin therapy. The risk is lower with oestrogen-only therapy or short-term use.
Increasing the risk of endometrial cancer (cancer of the lining of the uterus) with oestrogen-only therapy, unless it is balanced by progesterone or progestin. This is why women who still have a uterus need to take both hormones together.
Increasing the risk of blood clots, especially in the legs (deep vein thrombosis) or lungs (pulmonary embolism), which can be life-threatening. The risk is higher with oral HRT than with topical or vaginal HRT.
Increasing the risk of stroke in older women (over 60) who start HRT long after menopause, as oestrogen may have a harmful effect on the blood vessels and blood pressure.

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Types of HRT

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There are different types of HRT available, depending on your symptoms, preferences, and medical history. The main types are:

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Systemic HRT: This type of HRT delivers hormones to the whole body through the bloodstream. It can be taken as a pill, a patch, a gel, a spray, or a ring. Systemic HRT can treat all menopausal symptoms, including hot flashes and bone loss.
Low-dose vaginal HRT: This type of HRT delivers hormones directly to the vagina through a cream, a tablet, or a ring. Low-dose vaginal HRT can treat vaginal symptoms only, such as dryness and atrophy. It has minimal effects on the rest of the body.

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Within each type of HRT, there are different formulas and dosages of hormones that can be tailored to your needs. You can choose between:

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Oestrogen-only therapy: This is suitable for women who have had their uterus removed (hysterectomy), as they do not need progesterone to protect against endometrial cancer. Oestrogen-only therapy can be systemic or vaginal.
Combined oestrogen-progestin therapy: This is suitable for women who still have a uterus, as they need both hormones to balance each other and prevent endometrial cancer. Combined therapy can be systemic or vaginal.
Cyclical or sequential therapy: This is a type of combined therapy that mimics the natural menstrual cycle by taking oestrogen every day and progesterone for part of the month. This causes monthly bleeding similar to a period. Cyclical therapy is usually recommended for women who are still having periods or who are within one year of their last period.
Continuous therapy: This is a type of combined therapy that involves taking both hormones every day without a break. This causes no bleeding or irregular bleeding for the first few months, then no bleeding at all. Continuous therapy is usually recommended for women who have not had periods for more than one year.

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How to decide if HRT is right for you

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HRT is a personal choice that depends on your symptoms, health risks, preferences, and goals. You should discuss with your doctor the pros and cons of HRT for your situation before making a decision.

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Some factors to consider are:

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The severity and impact of your menopausal symptoms on your daily life
Your age and time since menopause
Your personal and family history of breast cancer, endometrial cancer, blood clots, heart disease, stroke, and osteoporosis
Your lifestyle habits, such as smoking, drinking, diet, and exercise
Your preferences for the type, formula, and dosage of HRT
Your expectations and goals for HRT

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Treatments Of HRT

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HRT is not a one-size-fits-all treatment. You may need to try different types or doses of HRT to find the one that works best for you. You should also have regular check-ups with your doctor to monitor your response and adjust your treatment as needed.

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HRT is not a long-term treatment. You should use the lowest effective dose for the shortest possible time to achieve your goals and minimise the risks. The current recommendation is to use HRT for no more than five years unless you have a strong indication to continue.

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Conclusion

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HRT is not the only option for managing menopausal symptoms. There are other treatments and strategies that can help, such as lifestyle changes, alternative therapies, and non-hormonal medications. You should explore all the available options and find the best combination for you.

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