HORMONE REPLACEMENT THERAPY

by Dr Jean Coope

The following information is designed to advise you on why and how to take your Hormone Replacement Therapy (HRT).

If you should have any further questions or are unsure about anything, your doctor or pharmacist can help.

The name of your HRT is -

The treatment is designed to put back the hormones which your ovaries stop producing around the time of the menopause (the last period). The hormones may be used for two reasons. First, they will reduce any symptoms you may have developed because of lack of oestrogen, e.g. flushes, night sweats, vaginal dryness or irritability. They will also help prevent you getting osteoporosis (brittle bone disease). If you take hormones for five years or more, the risk of fractures is reduced by about 50%. This does not mean that you will definitely avoid a fracture, but the risk of injury is reduced. Heart attacks and stroke are less common in women who take HRT.

HRT - Important points

Health checks

1. Make sure it is alright for you to take HRT. It may not be if you have previously had a cancer of the breast or womb.
2. Look at the label on the box or packet. It will tell you how to take your HRT.
3. HRT may be given before your periods have come to a complete stop.
4. If you have had a hysterectomy, you will only need to take the oestrogen.
5. If you have not had a hysterectomy, you should take two hormones, oestrogen and progestogen. The progestogen is a hormone which prevents excessive thickening of the lining of the womb. It is taken as a separate tablet or patch for the last 10-12 days of the month, or is incorporated with the oestrogen for the same length of time.
6. Women who cannot take oestrogen may be given progestogens which also help control flushes and prevents the loss of bone thickness at the menopause.
7. Keep taking the course of treatment until you have come to the end of the pack.

If you are over 50 you may be invited to have a mammogram, which is a soft X-ray of the breasts. This is a bit uncomfortable, but the radiation is low dose and not harmful. This is an accurate test which picks up breast cancer very early. If enough women accept the offer of mammography, many lives should he saved. It is an important screening test for women on HRT.

Before taking your HRT

• Have you had any irregular or very heavy bleeding lately? If so, consult your doctor.
• Do not take HRT if there is any chance you might be pregnant.
• If you have had a thrombosis or a clot on the lung, consult your doctor before starting treatment.
• If you are going to have a major operation like hysterectomy or hip replacement, it may be a good idea to postpone HRT until you are mobile again.

Taking your HRT

• You must take your tablets or apply your patches regularly. If they are in a calendar pack, make sure you use them in the right order and finish the pack.
• If you forget to take a tablet or apply a patch, do so as soon as you remember. Then go on as before.

After taking your medicine

• It is uncommon to get anything more than mild side-effects. You may get a little breast tenderness or nausea at first. These feelings tend to wear off after a few days.
• Do not expect to notice any great benefits until you have been on the treatment for two or more weeks.
• Whether or not you are still having periods, it is likely that you will get a period at the end of each packet of HRT (unless you have had a hysterectomy). This does not necessarily mean that you are still fertile. It is a "false" period caused by the hormones. Some women on HRT do not bleed: this is quite normal. If bleeding occurs on more than one occasion during the month, and you have not forgotten to take the HRT, consult your doctor.
• HRT does not act as a contraceptive, so, if you are still getting your periods when you start the HRT, you will need to continue taking contraceptive precautions.
• Contact your doctor if you get any pains in your chest.
• Make sure you visit your doctor every three months on treatment so you can he monitored on a regular basis.

Stopping the HRT

• Do not stop taking the HRT as soon as you start feeling better, as the symptoms are likely to return. Discuss with your doctor before stopping treatment.
• Finish your treatment to the end of a packet.
• If you have been on HRT for a long time, you will need to cut down the dose slowly, to avoid a return of symptoms.

Some questions & answers

Q. What are the risks of HRT use?
A: There are risks and benefits associated with HRT. If you have any doubts about therapy, these should be discussed with your doctor prior to commencement of HRT.

Q Will HRT improve my sex life?
A: You will notice that the vagina is more moist and you will probably not need lubricants. However, HRT does not usually improve the sex drive, although male hormones may do so.

Q: Can women with high blood pressure take HRT?
A: In the majority of patients there is no evidence that blood pressure rises on HRT, but women are advised to have high blood pressure treated and monitored in the usual way.

Q: How long should I stay on HRT?
A: Recent studies have shown that the risk of breast cancer does not increase up to six years use. This period also gives considerable protection against fractures and heart disease. In the first instance it is useful to take HRT for 5-6 years provided there are no other contra-indications to therapy. Mammograms should be repeated periodically as advised by your doctor. Some women who have an early menopause, especially those who have had their ovaries removed, should stay on HRT longer.

Q: When should I start HRT?
A: The best time to prevent bone loss is when it is most rapid, just after the menopause or when periods are far apart. However, you may wish to start before this if you have flushes and mood changes.

Q: Will I gain weight on HRT?
A: Some women gain weight. This is due to water retention and can he treated with diuretics.

Q. Does HRT react with other drugs?
A: Cigarettes reduce the effect of oestrogen which is destroyed more rapidly in the liver of smokers. It is advisable to cut down your smoking. Anti-epileptic drugs have the same effect, so these patients may need to take a higher dose of HRT, please contact your doctor.

Q: What happens if I stop taking HRT?
A: You will suffer from hot flushes which may go on for months, but these are medically harmless. The drain on bone thickness which HRT prevents will now start again. However, for the rest of your life your bones will keep the additional strength given by hormones. For instance, if you are 65 and took HRT for five years, your bones are only 60 years old.

Q: Do I still have to have a period when taking HRT?
A: Recently new forms of hormone therapy have been developed which do not cause periods. If you have not had a hysterectomy you may find it helpful to discuss these treatments with your doctor

IMPORTANT: These tablets/patches are only for YOU. Only a doctor can prescribe them for you. Never leave them within reach of children or give any tablets or patches to someone else. The HRT may harm them.