Talk to your doctor about any concerns you may have. Women over 50 years of age who use combined oestrogen and progestogen progesterone replacement for less than five years have little or no increased risk of breast cancer. Women who use combined HRT for more than five years have a slightly increased risk.
Women on oestrogen alone have no increased risk up to 15 years of usage. There is no evidence to suggest that a woman with a family history of breast cancer will have an added increased risk of developing breast cancer if she uses HRT. The risk with combined oestrogen and progestogen is greater than with oestrogen alone, or with newer HRT agents such as tibolone sold as Livial or Xyvion , and may also depend on the type of progestogen used.
Studies suggest that medroxyprogesterone acetate and norethisterone have higher risks than dydrogesterone and progesterone. Women over 60 have a small increased risk of developing heart disease or stroke on combined oral tablet HRT. Although the increase in risk is small, it needs to be considered when starting HRT, as the risk occurs early in treatment and persists with time.
Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch. Similarly, tibolone increases the risk of stroke in women from their mids.
Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more.
Venous thromboses are blood clots that form inside veins. Women under 50 years of age, and women aged 50 to 60, face an increased risk of venous thrombosis if they take oral HRT.
The increase in risk seems to be highest in the first year or two of therapy and in women who already have a high risk of blood clots. This especially applies to women who have a genetic predisposition to developing thrombosis, who would normally not be advised to use HRT. Limited research to date suggests the increased risk of clots is mainly related to combined oestrogen and progestogen in oral tablet form, and also depends on the type of progestogen used.
Some studies suggest a lower risk with non-oral therapy patches, implants or gels or tibolone. The endometrium is the lining of the uterus. Use of oestrogen-only HRT increases the risk of endometrial cancer, but this risk is not seen with combined continuous oestrogen and progestogen treatment. There is no risk if a woman has had her uterus removed hysterectomy.
The increased risk of ovarian cancer is very small and estimated to be one extra case per 10, HRT users per year. A recent review linked HRT to two types of tumours: serous and endometrioid cancers. Cholecystitis is a disease in which gallstones in the gallbladder block ducts, causing infection and inflammation.
On average, there is a slightly higher risk that a woman will develop cholecystitis when using oral HRT, but patch treatment is associated with a lower risk. Treatment for cholecystitis includes surgery to remove the gallbladder.
Weight gain at the menopause is related to age and lifestyle factors. An increase in body fat, especially around the abdomen, can occur during menopause because of hormonal changes, although exactly why this happens is not clear. Normal age-related decrease in muscle tissue, and a decrease in exercise levels, can also contribute to weight gain. Most studies do not show a link between weight gain and HRT use. If a woman is prone to weight gain during her middle years, she will put on weight whether or not she uses HRT.
Some women may experience symptoms at the start of treatment, including bloating, fluid retention and breast fullness, which may be misinterpreted as weight gain. These symptoms usually disappear once the therapy doses are changed to suit the individual. HRT is not a form of contraception. Hormone replacement therapy primarily focuses on replacing the estrogen that your body no longer makes after menopause.
There are two main types of estrogen therapy:. If you haven't had your uterus removed, your doctor will typically prescribe estrogen along with progesterone or progestin progesterone-like medication. This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer.
If you have had your uterus removed hysterectomy , you may not need to take progestin. In the largest clinical trial to date, hormone replacement therapy that consisted of an estrogen-progestin pill Prempro increased the risk of certain serious conditions, including:. All of these risks should be considered by you and your doctor when deciding whether hormone therapy might be an option for you.
If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost. You may be able to manage menopausal hot flashes with healthy-lifestyle approaches such as keeping cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxation techniques.
There are also several nonhormone prescription medications that may help relieve hot flashes. For vaginal concerns such as dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief.
You might also ask your doctor about the prescription medication ospemifene Osphena , which may help with episodes of painful intercourse. To determine if hormone therapy is a good treatment option for you, talk to your doctor about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years.
As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. If you continue to have bothersome menopausal symptoms, review treatment options with your doctor on a regular basis. There is a problem with information submitted for this request.
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You may opt-out of e-mail communications at any time by clicking on the Unsubscribe link in the e-mail. If women start HRT around the time of menopause the risk is very small and there appear to be cardiovascular and bone protective benefits. It is not usually appropriate for women over 60 to be starting HRT but as the WHI study shows, women initiating it over 60 years do not seem to be at increased risk of cardiovascular events or mortality.
Many women seek advice on the effects of HRT on sexual activity and desire. Whilst there is no definitive answer, case studies indicate that the estrogen in HRT can help maintain or return sex drive.
It will also help other menopausal symptoms such as vaginal dryness and pain with intercourse. If vaginal symptoms are the only problem, then the use of local vaginal estrogen or dehydroepiandrostenedione DHEA may be preferable. Bio-identical hormones are hormone preparations which are identical molecules to those produced by the body. Indeed, they may be less safe — their production is not monitored by government drug regulatory authorities and thus their dosage may be inaccurate or inconsistent, their purity is certainly not guaranteed, and their safety is not tested as it is with approved HRT formulations.
The accuracy and usefulness of such tests are highly questionable. We would not recommend the use of bio-identical hormones that have not been licensed by the UK regulatory authorities, and indeed would strongly caution women against obtaining such products. There are more than 50 types of HRT available: HRT can be given orally tablets , transdermally through the skin ; subcutaneously a long-lasting implant ; or vaginally.
Women wishing to start HRT should carefully discuss the benefits and risks of treatment with their doctor to see what is right for them, taking into account their age, medical history, risk factors and personal preferences. For the majority of women who use HRT for the short-term treatment of symptoms of the menopause, the benefits of treatment are considered to outweigh the risks.
The lowest effective HRT dose should be taken, with duration of use depending on the clinical reasons for use. HRT remains licensed for osteoporosis prevention and can be considered the treatment of choice for women starting treatment below age 60 years, and especially for those with a premature menopause. Women on HRT should be re-assessed by their doctor at least annually. For some women, long-term use of HRT may be necessary for continued symptom relief and quality of life.
Many health centres and practices have a doctor with a special interest in postmenopausal health.
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