5.4 Annual HRT Review

The menopause is when you stop having your periods. It happens when your ovaries stop releasing eggs or your ovaries have been removed and the amount of oestrogen hormone in your body falls. Most women in the UK have their menopause between the ages of 45 and 55 years, with the average age being 51 years. Menopause can occur earlier in some women. If it occurs before the age of 40 years, it is known as premature menopause or premature ovarian insufficiency. The time before your last period, when your oestrogen levels are falling, is called the perimenopause. This can last from a few months to several years. Around half of all women notice physical and/or emotional symptoms during this time.

The most common symptoms are:
• hot flushes
• night sweats
• vaginal dryness
• low mood and/or feeling anxious
• joint and muscle pain
• loss of interest in having sex.
Every woman experiences the menopause differently. Some experience one or two symptoms, which may be mild, while others have more severe and distressing symptoms. Some women choose to go through the menopause without treatment, while others prefer some form of treatment to manage their symptoms, by using either hormone replacement therapy (HRT) or an alternative treatment.

HRT is the most common form of prescribed treatment for menopausal symptoms. It helps to replace the hormone oestrogen in your body, which decreases around your menopause. You may sometimes also need other hormones (such as progestogen and testosterone) that your body is no longer producing.
If you are interested in taking HRT, your healthcare professional should discuss the benefits and risks with you before you start the treatment. This discussion should cover both the short-term (over the next
5 years) and the longer term (beyond the next 5 years) benefits and risks for you. You should also be informed about available alternatives to HRT along with their benefits and risks.

• It is an effective treatment for hot flushes and low mood associated with the menopause.
• It can improve sexual desire and reduce vaginal dryness.
• It helps keep your bones strong by preventing osteoporosis

• HRT with oestrogen alone (used for women who have no uterus) is associated with little or no
  increased risk of breast cancer.
• HRT with estrogen and progestogen can increase your risk of breast cancer. This risk is higher the
  longer you stay on it and reduces when you stop HRT. Your individual risk of developing breast cancer depends on underlying risk factors, such as your body weight and your drinking and smoking habits.
• HRT taken as a tablet increases your risk of developing a blood clot, which is not the case if HRT
  is taken as a patch or gel.
• HRT in tablet form slightly increases your risk of stroke, although the overall risk of stroke is very
  low if you are under the age of 60 years

You may notice some vaginal bleeding in the first 3 months of starting or changing HRT, but if you
experience any bleeding after 3 months then you should see your healthcare professional straight away

HRT does not provide contraception. You need to continue using contraception for 1 year after your last
period if this happens after the age of 50 years. If your last period happens before you are 50 years of age
then you need to continue using contraception for 2 years.

There are no set time limits for how long you can be on HRT. The benefits and risks of taking HRT will
depend on your individual situation, and your healthcare professional should discuss these with you.