What type of HRT can I have?
If you have had your uterus (womb) removed you only need oestrogen HRT.
If you still have your uterus you need both oestrogen and a progestogen (combined HRT) to stop the lining of the uterus building up and in rare cases developing endometrial cancer. This is divided into continuous combined or sequential combined HRT and we can discuss which is best for you.
Some women may also benefit from testosterone.
HRT can be delivered by tablets, patches, gels or spray, and we can discuss the most suitable option for you.
What are the side-effects and risks of HRT?
There are so many myths about HRT that are still being perpetuated and many doctors are still very cautious about prescribing it despite the proven benefits. Typical misconceptions are that it makes you put on weight, that you can’t have it if you get migraine or blood clots or have a family history of breast cancer, that it just delays your menopause and that you should only be on it it for the shortest possible time.
The biggest worry for most women is the risk of breast cancer but this does not apply to all types of HRT and for the types it does apply to the risk is much smaller than we had been led to believe. I can discuss the research and look at this risk in relation to other factors for breast cancer and how you can reduce your personal risk.
There is a small increased risk of blood clots and ischaemic strokes with the tablet forms of oestrogen but not with the patch and gel forms of HRT.
What are the long term benefits of HRT?
If you start HRT before the age of 60 and within 10 years (but ideally within 5 years) of your last period, you have a significantly reduced risk of heart disease in the future. Long-term HRT can also protect against osteoporosis. Women on continuous combined HRT have a lower risk of endometrial cancer than those on no HRT at all.
What about testosterone?
Dr Balfour is able to prescribe this if indicated. Many people don’t realise that testosterone is a really important hormone for women as well as men. We produce it both in our ovaries and via our adrenal glands and production naturally declines with age. Our levels reduce more dramatically if our ovaries are removed or stop functioning at a young age. Testosterone may be indicated to help libido but in some women it can also improve motivation, mood, energy levels, concentration, muscle strength and stamina. You would normally have a trial of an adequate dose of oestrogen (with progestogen if you still have a uterus) for at least 6 months before considering whether testosterone is also needed to help with your symptoms. Younger women with a surgical menopause are most likely to need testosterone supplementation.
How can I improve my vaginal symptoms?
As we lose oestrogen we all develop thinning of the tissues of the vagina, vulva and bladder. This is not something that settles after the menopause but steadily gets worse, often leading to vaginal burning and itching, painful sex, urinary frequency and recurrent urinary tract infections. Some women find that having a smear becomes more uncomfortable as they get older because of this. All these symptoms can be helped by the regular, long term use of vaginal oestrogen which is very safe and effective. It does not increase the risk of breast cancer and those still with their uterus do not need to have a progestogen as well.
Most women on HRT find their vaginal symptoms are greatly improved but about 20% find they need to add in long term vaginal oestrogen.