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HRT: The Pros and the Cons

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I’ve recently gone through the menopause and although some of the symptoms have alleviated somewhat, I’m still getting hot flushes and night sweats. I’ve looked into HRT treatments but am non-the-wiser about which ones to use. Any advice or suggestions would be gratefully received. Many thanks in advance.  

Women's ovaries progressively produce less and less oestrogen in the period up to the menopause, and oestrogen levels in the blood decline as a result. These reduced levels can cause distressing symptoms including mood swings and vaginal dryness or itching, as well as hot flushes and night sweats.

There are a plethora of Hormone Replacement Therapy (HRT) treatments available that help alleviate the symptoms by simply replacing or supplementing the reduced levels of oestrogen. However, before you start any form of HRT treatment, you must be aware of both the pros and the cons. We’ll take a look at the cons later but first of all, let’s have a look at the various types of HRT treatments that are available.

Elleste Solo (Estradiol Hemihydrate)

Elleste solo menopause tablets contain the active ingredient estradiol hemihydrate which is a naturally occurring form of oestrogen, and thus helps alleviate the symptoms brought on following menopause when taken. Elleste Solo hormone replacement therapy is only prescribed if the symptoms seriously affect day-to-day life.

Premarin Treatment

Premarin is used after menopause to reduce moderate to severe hot flashes, menopausal changes in and around the vagina, and to help reduce the chances of getting osteoporosis (thin, weak bones). The menopause tablets contain conjugated estrogens, a mixture of estrogens obtained from natural sources. If you are using or are considering using Premarin to only treat vaginal symptoms (not osteoporosis as well), consider topical therapies first.

Femoston

Femoston is a Hormone Replacement Therapy (HRT) which contains two types of female hormones; an oestrogen and a progestogen. Femoston menopause tablets are used in postmenopausal women at least 6 months since last menses and will only be prescribed if your symptoms seriously hinder your daily life.

Prempak-C

Prempak-C is a hormone replacement therapy preparation. It is available in two strengths but whichever strength you choose, or are prescribed, each pack will contain two types of tablets. One type of tablet contains conjugated oestrogens and the other, norgestrel. Conjugated oestrogens and norgestrel are forms of the main female sex hormones, oestrogen and progesterone.

Prempak-C is a sequential form of combined HRT. This means that oestrogen is taken on a continuous basis while progesterone is just added for a portion of each month.

Evorel Patches

Evorel helps supplement the declining levels of oestrogen in the form of a square shaped, transparent, self-adhesive patch. Oestrogen, in this case in the form of estradiol, is therefore taken though the skin surface.

Evorel Sequi/Evorel Conti

Evorel Sequi contains two hormones, estradiol and norethisterone acetate. It comes in a pack as two patches - Evorel 50 is an oestrogen only patch while Evorel Conti is a combination of the hormones oestrogen and progestogen.

All of these treatments have been proven to alleviate the symptoms associated with menopause, but before you decide which is most suitable for you, let’s touch upon the potential negatives of HRT.

As with the large majority of medications out there, there are some possible minor side effects associated with oestrogen HRT. These include fluid retention, bloating, breast tenderness or swelling, nausea, leg cramps, headaches and indigestion.

However, simple, small lifestyle changes can help to relieve the side effects, including:

  • taking your oestrogen dose with food, which may help to reduce nausea and indigestion
  • eating a low-fat, high-carbohydrate diet, which may reduce breast tenderness
  • regular exercise and stretching, which can help to reduce leg cramps

Likewise, there are some potential side effects associated with progestogen HRT which include fluid retention, breast tenderness, headaches, mood swings, depression, acne and backache.

Additionally, many women believe taking HRT will make them put on weight, but there is no evidence to support this claim. You may gain some weight during the menopause, but this often happens regardless of whether you take HRT or not. Exercising regularly and eating a healthy diet should enable you to lose any unwanted weight.

There are however some more serious risks associated with HRT treatments which you also need to be aware of, such as an increased risk of breast and ovarian cancer. Indeed, research has shown that taking HRT does increase the risk of developing breast cancer, with combined HRT presenting a higher risk than oestrogen-only HRT. Furthermore it revealed it also slightly increases the risk of developing ovarian cancer.

Before deciding upon whether to start HRT, you may want to consult your doctor to discuss the genetics of cancer if it runs in your family and if HRT is a plausible treatment for your menopausal symptoms. Alternatively, we have in-house doctors who would be happy to talk you through any concerns you may have.

I do hope this helps you, and please do let us know whether you decide to proceed with HRT and whether it helps.

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