HRT – or hormone replacement therapy, to give it its Sunday name – is a well-known treatment in menopause, helping women cope with symptoms such as hot flushes, night sweats and more.
But it is not just one form of medication (you can read my search for the right HRT here) and the different terms and phrases used around it can be complicated.
What is HRT?
It’s what it says on the tin: hormone replacement therapy to top-up the hormones that we start losing when we go through menopause.
Basically, it’s a way of boosting your oestrogen and progesterone to levels that relieve menopause symptoms. Some people say it should be called it hormone supplementary therapy because it supplements what we’re lacking in the way taking a multi-vitamin does.
The two main hormones it boosts are
- oestrogen – types used include estradiol, estrone and estriol;
- progestogen – a man-made version, such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel.
What are the different types of HRT?
There are various different ways to take HRT:
My first HRT was tablets, taking once a day, containing two weeks of oestrogen and two weeks of progesterone. They are the most common form, but I now avoid them as the health risks are a little higher than with other forms. Plus they didn’t do anything for me. (You can read more about the risks and benefits of HRT here.)
These are simple patches that you stick on your skin (usually below the waist) and change weekly or twice-a-week, again with a dose of oestrogen and then progesterone. They’re as simple as that.
HRT patches have lower risks than tablets. But they do leave a black sticky residue on your skin when you take them off! Baby oil cleans it off.
My current form. Mine comes in a pump and you simply rub it into your skin (on your upper arm and shoulder or inner thigh).
Oestrogen gel doesn’t increase your chances of blood clots, but obviously, as you need to be aware of general hormone therapy risks and watch your body. I now take my blood pressure twice a month, for example.
Little pellet-type items that get placed under your skin (they use a local anaesthetic!) and then release a stream of oestrogen in your body.
One of the advantages is they last for several months, so you don’t need to remember a thing (which can be handy in menopause).
Unless you’ve had a hysterectomy, you will need to take progesterone with the gel and implants to protect the lining of your womb.
This is used mainly as a way of dealing with vaginal dryness. It is a ring, cream or pessary that you insert in your vagina.
It carries no risk with it.
You may get testosterone if your sex drive is still low and HRT isn’t helping. I was told it would be good to help with my fatigue and low energy levels. My GP said this was a “leftfield” idea…
You can read more about me and testosterone here.
What is the best form of HRT to take?
That depends of A: your personal preference; B: what your GP will give you (which isn’t always what you want), and C: where you are in your menopause.
Okay, I can’t do anything about A and B, so let’s look at where you are in your menopause. HRT comes in two forms: cyclical and continuous.
Also known as sequential, there are two types:
- monthly: when you take oestrogen every day and take progestogen alongside it for the last 14 day of your menstrual cycle (what I’m doing now);
- three-monthly: you take oestrogen every day and take progestogen alongside it for around 14 days every three months.
Now I’d never heard of three-monthly and with my progesterone sensitivity, it sounds like something I’d like to explore if the current regime doesn’t work. (See? The power of knowledge.)
Monthly is usually given if you’re still having regular periods and three-monthly if they’re irregular.
Continuous combined HRT
With this, you get a dose of oestrogen and progesterone every day. You can take this if you are post-menopausal (find out what that means here).
What is the difference between bioidentical and body identical HRT?
There isn’t any; it’s how people use these terms that causes problems.
Once more, we’re talking about two forms. The first is known, technically, as rBHRT, which stands for regulated bioidentical hormone replacement therapy. The second is cBHRT – custom compounded bioidentical hormone replacement therapy.
At its simplest, rBHRT is what your GP will prescribe. It is an identical duplicate of the hormones you’ll find in your body, hence the term bioidentical or body identical. They are safe and regulated, meaning you can get a prescription for them from your GP.
What happens is, however, some manufacturers and private clinics call their custom-made HRT – cBRHT – “bioidentical”, too. These are therapies where the mix of hormones comes in differing amounts depending on what the prescriber thinks is appropriate for you. Plus some of them use hormones that are not approved for women, which is why they are unregulated and not available on the NHS.
And despite what the clinic may try to tell you, there is no evidence that this form is more effective or has few side effects or is safer than what your GP will give you.
Always check out the NICE guidelines if you have doubts.
The cost of HRT
I am not going to rant, but HRT is usually a double prescription charge in England because it is classed as two treatments. Even though it comes in one packet or one blister pack.
Have I missed something? Let me know in the comments below.