Hormone Replacement Therapy (HRT): A Comprehensive Guide

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Hormone Replacement Therapy (HRT): A Comprehensive Guide

Table of Contents

  1. Introduction
  2. Recommended Indications
  3. Vaginal Symptoms and Treatment
  4. Who Should Consider HRT?
  5. The Role of Estrogen
  6. Dosage Tips
  7. Combined Regimens
  8. Duration of HRT
  9. Tips on Stopping HRT
  10. Summary


Hormone Replacement Therapy (HRT) is a recommended first-line treatment for menopausal symptoms, including flushes, sweats, low mood, anxiety, and joint aches. These symptoms can significantly impact quality of life. HRT also offers long-term benefits for bone and heart health, especially in women at increased risk.

Recommended Indications

Current indications for HRT include the treatment of troublesome menopausal symptoms, early menopause or premature ovarian insufficiency, and the treatment or prevention of osteoporosis in high-risk women.

Vaginal Symptoms and Treatment

If menopausal symptoms are primarily related to vaginal dryness, irritation, or discomfort, vaginal estrogen may be more effective than HRT. Vaginal estrogen is concentrated in the vaginal and bladder areas with minimal absorption throughout the body, unlike systemic HRT.

Who Should Consider HRT?

Due to the vast differences in symptoms, medical history, and individual responses, HRT necessity varies among women. It's essential to evaluate the need for HRT based on symptoms, severity, and impact on daily life.

The Role of Estrogen

Estrogen is the primary component of HRT, aiming to replace the diminished estrogen levels responsible for menopausal symptoms. Starting with a low dose is advisable, with adjustments based on symptom control. Regular evaluation and consideration of non-hormonal options, such as Cognitive Behaviour Therapy (CBT), can be valuable.

Dosage Tips

For ease and convenience, tablet forms of estrogen are common, while transdermal options (patch, gel, or spray) may be recommended for specific medical conditions. Progestogen is necessary if the womb is present, with the duration depending on the menstrual cycle status.

Combined Regimens

Regimens are simplified when progestogen is combined with estrogen, either in a daily tablet or patch. Irregular bleeding is typical in the first 3 to 6 months, with investigation warranted if severe or persistent. Continuous combined regimens tend to cause less bleeding.

Duration of HRT

HRT may not be required for a prolonged period, as symptoms often resolve. It's essential to balance benefits against risks, particularly the small increased risk of breast cancer associated with long-term use. A trial off HRT can help determine ongoing necessity.

Tips on Stopping HRT

When deciding to stop HRT, staying off for at least 3 months before evaluation is recommended. Weaning off should be gradual, and irregular use may lead to bleeding problems. If symptoms return, reassess the impact and explore non-hormonal options.


  • Not all women need HRT, and there should be no pressure to take it.
  • Addressing diet and lifestyle issues is crucial for symptom management and long-term health.
  • If choosing HRT, discuss dosage, route, need for progestogen, and regimen.
  • Appropriately used, HRT offers more benefits than risks for most women under 60 or within 10 years of menopause.
  • Be mindful of long-term risks and balance them against individual benefits.
  • HRT is rarely a lifelong necessity; carefully consider when to stop.