Hormone replacement therapy (HRT)

Also called HRT or menopause replacement therapy

Easy-to-read medicine information about hormone replacement therapy (HRT) – what it is, how to take it safely and possible side effects.

What is HRT?

During menopause, the amount of oestrogen produced by a woman's body drops and this can cause symptoms associated with menopause such as hot flushes, night sweats, sleep problems, muscle and joint pains, mood changes, vaginal dryness and discomfort with sex. Read more about menopause.

Hormone replacement therapy (HRT) is also known as menopausal hormone therapy (MHT) and hormone therapy (HT). It is the use of hormone therapy (tablets, patches or cream) to replace the oestrogen that your ovaries no longer make during and after menopause. It can help relieve some of the symptoms of menopause.

Hormone therapy may have either oestrogen alone or oestrogen plus progestogen, depending on what is best for you. HRT is not recommended in certain situations, such as for women who have a history of breast cancer, are at risk of heart disease, or have had a blood clot or are high risk of having a blood clot. Ask your doctor whether HRT is right for you – there are also other non-HRT options that can help with menopausal symptoms.

  • For women who still have their uterus, HRT will have both oestrogen and progestogen. This is because oestrogen alone can overstimulate the cells lining your uterus, causing an increased risk of endometrial cancer (cancer of the uterus). To counter this risk, women who have a uterus are advised to take progestogen together with oestrogen.
  • In women who have had their uterus removed surgically (hysterectomy), HRT will have oestrogen alone.


Image credit: MHT Australasian Menopause Society

Examples of HRT

HRT is available as oestrogen alone or as oestrogen with progestogen. It is also available in different formulations such as creams, pessaries, tablets and skin patches. Some of these are used every day, while others may be used only for a few days or once or twice a week.

The following are examples of HRT products available in New Zealand. The choice of product depends on your individual circumstances and preferences. When using HRT, use the lowest dose that eases your symptoms for the shortest time and get your treatment reviewed at least once every year to assess whether to continue it or not.

HRT Description
Oestrogen (vaginal) Vaginal oestrogen is available as a cream or as pessaries that are inserted into your vagina. It is used to ease bladder and vaginal symptoms of menopause, such as vaginal dryness, burning or itching. It only acts on your vagina and bladder and is suitable for most women. 
  • Ovestin cream®
  • Ovestin pessaries®

Read more about Ovestin cream and pessaries

Oestrogen (tablets)
  • Estriol (Estrofem®)
  • Estradiol valerate (Progynova®)
  • Estriol (Ovestin®)
  • Estrogens (Premarin®)
Oestrogen
(skin patch)

These patches are applied to your skin 1 or 2 times a week:

  • Estradiol Estradot® (change patch 2 times a week)
  • Estradiol Climara® (change patch once a week).
Oestrogen plus progestogen (tablets)
  • Estradiol and norethisterone (Trisequens®, Kliogest®, Kliovance® )
Bazedoxifene plus oestrogen 
  • Also called Duavive® tablets.
  • This is a combination of oestrogen plus a non-hormone medicine, bazedoxifene.
  • It is an option for women who have a uterus but for whom taking progestogen is unsuitable. 
Tibolone
  • Also called Livial® tablets.
  • This isn’t oestrogen or progesterone, but it works in a similar way.
Progestogens 
  • These are used together with oestrogen in women who still have their uterus.
  • Examples of progestogen tablets and capsules are Utrogestan®, Primolut N® and Provera®.
  • It is also available as a gel called Crinone®. 

What are the benefits of HRT?

Without treatment, menopausal symptoms such as hot flushes, night sweats, sleep problems and headaches may last for a few years. Most women manage their menopause symptoms themselves, but some may need help from their doctor. HRT has been found to:

  • reduce the number and severity of hot flashes and night sweats
  • improve symptoms of vaginal dryness and soreness
  • help to reduce recurrent urine infections
  • lower the risk of osteoporosis, because oestrogen slows bone thinning and helps increase bone thickness
  • slightly reduce the risk of diabetes.

What are the risks of HRT?

When assessing the risks associated with HRT, remember that not all women have the same risk of these effects.

  • Risks vary based on how old you are, when you start HRT and how long you take it for. 
  • Short-term use in early menopause has fewer risks than when it is started later in menopause.
  • Risks generally increase as you get older.
  • The risks of developing blood clots while taking HRT is much higher for women who are obese, have severe varicose veins or have a close family member who has had deep vein thrombosis or pulmonary embolism.
Women who take HRT have slightly higher rates of  the following conditions:

  • Blood clots: 
    • Women who take HRT in tablet form have a small increase in the risk of blood clots in their veins. The increase in risk is between 1 and 2 per 1000 each year for women aged between 50 and 60 years.
  • Breast cancer:
    • Long-term use of combined HRT may be associated with an increased risk of breast cancer. This risk is less than 1 in 1000 women, and is not seen for 7 years in women using HRT for the first time. Oestrogen-only therapy does not increase breast cancer risk and the chance of dying from breast cancer is not increased in women using HRT.
  • Heart disease and stroke if older than 60 years or used HRT for more than 10 years.
  • Gallstones.
  • Worsened urinary incontinence.

For most women with moderate to severe symptoms, the benefits appear to outweigh the risks for those who are less than 10 years out from menopause or aged less than 60.

What are the side effects of HRT?

HRT can cause side effects such as breast tenderness, fluid retention, mood changes, menstrual spotting and bleeding. If you get any of these side effects, talk to your doctor as you may need a change of dose. HRT does not cause weight gain.

Contact your doctor immediately if you get any of the following symptoms while taking HRT:

  • sudden severe chest pain (even if it isn't radiating to your left arm)
  • sudden breathlessness
  • unexplained swelling or severe pain in the calf of one leg
  • severe stomach pain or yellowing of your skin
  • serious neurological effects, including the following:
    • unusual severe, prolonged headache, especially if it is the first time or getting progressively worse
    • sudden partial or complete loss of vision
    • sudden disturbance of hearing or other perceptual disorders
    • difficulty with your speech
    • bad fainting attack or collapse
    • first unexplained epileptic seizure
    • leg or arm weakness or a droopy face
    • very marked numbness suddenly affecting one side or one part of your body.

If you are taking HRT and have recently had surgery or a leg injury and you are unable to walk around, contact your doctor for advice.

If you are taking HRT and decide to stop, ask your doctor how to stop safely. You may need to stop slowly over several weeks.

Complementary therapies

Many women consider using complementary therapies such as phytoestrogens. These oestrogen-like compounds are found in all plants but are in highest quantities in legumes, including beans and soy products. Some women find these compounds helpful, although scientific studies have found them no better than a placebo. A lack of response after 6 weeks should be seen as a reason to stop.

Similarly, scientific studies have also found the following to be no better than a placebo: black cohosh, dong quai, evening primrose oil, red clover and ginseng. Due to possible adverse effects on your liver, it is recommended that black cohosh treatment be ceased after 6 months.

All complementary therapies may have side effects and may interact with prescription medicines, so tell your doctor if you are using or planning to use these.

Learn more

The following links have more information on HRT. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.
Menopause Family Planning, New Zealand 
Menopause health information Australasian Menopause Society
Menopause and HRT  Patient Info, UK
Facts about menopausal hormone therapy National Institutes of Health, US 

Medsafe Consumer Information Sheets:
Trisequens
Kliogest
Kliovance 
Progynova
Estradot
Climara
Premarin

References

Credits: Sandra Ponen, Pharmacist. Reviewed By: Dr Jeremy Steinberg, GP and Angela Lambie, Pharmacist, Auckland Last reviewed: 19 Sep 2019