HRT: Your Options

Disclaimer: HRT is not for everyone. There are medical and personal reasons why HRT may not be right for you. The following is written to help you understand your options when considering HRT but is not meant to replace the advice of your medical practitioner.

Choosing whether or not to take HRT is a big decision and I hope this information helps you in some small way.

Women going through an early menopause are prescribed HRT to alleviate complications of oestrogen deficiency. As well as the typical menopausal symptoms, this includes negative effects on your bones and possibly your heart.

In finding the right formulation of HRT, it’s been my experience that doctors work on the ‘trial and error’ principle. Basically, they start you on a low dose to avoid putting in too much oestrogen as that can cause symptoms like breast tenderness and nausea. Then, if you still have menopausal symptoms (flushes, sweats etc.), they raise the dose and try to just get that balance right between too little oestrogen (which causes the menopausal symptoms) and too much oestrogen in your system. OK, still with me?!

The main goal in symptom control is to increase your oestrogen levels to where they should be for a woman your age. Women with a uterus are prescribed combined HRT (oestrogen with a progestin) to protect the endometrium (womb lining) from overstimulation by the oestrogen. Getting the progestin component right can also be tricky as you may get symptoms like bloating and headaches. 

There are other choices to make also:

  1. You have a few methods of delivery available – tablets, patches, gels, implants – depending on which suits you better. There is a school of thought that the liver may be damaged when it processes tablets. (NB. There is, to date, no evidence that progesterone creams protect the endometrium the way progestins do.)
  2. You have a choice of plant-derived or animal-derived oestrogens. You might feel bad for the animals (like me), but those preparations have been studied for longer.
  3. You can choose between continuous (no bleed) or cyclical (monthly bleed) treatment.
  4. You need to weigh up the pros and cons for your personal medical history. If there is a history of hormone-sensitive cancers in your family, or blood clots, these are things that might steer you away from using HRT.

Your doctor should discuss all these issues with you along with alternatives for symptom control.

There is much debate on the pros and cons of HRT. Unfortunately, there have been no long-term studies done on young women, but the current thinking is that it’s ok for us as long as we’re otherwise fit and healthy. So keep that diet varied and healthy, and incorporate some regular exercise into your lifestyle; the positive influence of these two factors cannot be overstated.

It’s a big decision and one only you can make for yourself. So get informed and get confident. And remember, you can always change your treatment regime if you feel it’s not right for you anymore – it’s your body after all!

For more information please try the following:

  • www.menopause.org.au – In their Education section they have some good patient information sheets, particularly “Menopause – Combined HRT”, and “Early Menopause due to premature and unexpected ovarian failure”.
  • www.earlymenopause.com – Full of useful information. In their Special Topics section they have a great article “The WHI HRT study – what does it mean for younger women?
  • Elsewhere in our General Discussion board I’ve posted a notice that I keep updated with the latest scientific thinking on “Bioidentical” hormones. Click here for more.
  • On our website is a link to a group discussion on HRT. Click here for more.
  • I can send you a copy of the article “The role of HRT in the management of POF”. It was published in Nov ’07 and gives relevant and up-to-date advice.
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