Hormone Replacement Therapy

Question 1

What is HRT?

Answer 1

A treatment to relieve symptoms of menopause by replacing hormones that decrease as a woman approaches the menopause.

It typically involves small doses of oestrogen combined with a progestogen if a woman has a uterus to reduce the risk of endometrial cancer.

Question 2

What are indications for HRT?

Answer 2

Symptomatic relief of vasomotor symptoms such as flushing, insomnia, headaches, vaginal atrophy and dryness

Decreases the risk of osteoporosis and colorectal cancer

In premature ovarian insufficiency, HRT should be continued until the age of 50. This is to help prevent the development of osteoporosis

Question 3

What are contraindications for HRT?

Answer 3

Undiagnosed vaginal bleeding
Pregnancy
Breastfeeding
Oestrogen receptor-positive breast cancer
Acute liver disease
Uncontrolled hypertension
History of breast cancer or venous thromboembolism (VTE)
Recent stroke, myocardial infarction or angina

Question 4

How can HRT be given and when is a method preferred?

Answer 4

Can be given systemically, either via oral tablets, transdermal patches or gels, or can be given vaginally for urogenital atrophy, in the form of tablets, creams, pessaries or vaginal rings.

Transdermal is the preferred route if the woman is at risk of VTE.

Question 5

What are side effects?

Answer 5

Oestrogen: breast tenderness, leg cramps, bloating, nausea, headaches

Progestogen: premenstrual syndrome-like symptoms, mood swings, breast tenderness, backache, depression, pelvic pain, fluid retention, weight gain

Cholestatic jaundice
Increased risk of breast cancer, endometrial cancer, VTE, stroke and ischaemic heart disease