top of page

Types of HRT – What Are My Options?

HRT guidance from menopause doctor in Henley

What Is HRT?

HRT is hormone replacement therapy. It is designed to replace the hormones that your body produces less of as you go through menopause. HRT can help manage symptoms like hot flushes, mood swings, and vaginal dryness. It also plays a role in protecting your bone health and preventing conditions such as osteoporosis.


Types of HRT

There are different types of HRT with varying delivery methods - some are combinations of hormones. The right type for you will depend on factors such as your stage of menopause, your personal preferences and whether you’ve had a hysterectomy. Below are the main types of HRT:


1. Combined HRT (Oestrogen and Progestogen)

If you still have your womb, you’ll need both oestrogen and progestogen. Taking both is necessary to protect against the risk of cancer of the lining of the womb, which can increase if oestrogen is taken on its own.

How it's taken: You can use combined HRT in several forms, including tablets, skin patches, gels, sprays, and vaginal applications. You can also use oestrogen-only HRT combined with progestogen in tablet form or via an intrauterine system (IUS) like the Mirena coil.


2. Oestrogen-Only HRT

If you have had a hysterectomy (a surgical procedure where the womb is removed), oestrogen-only HRT is typically recommended. Since you no longer have a womb, there’s no need for progestogen, which is used to protect the lining of the womb in women who still have one.

How it's taken: Oestrogen-only HRT can be taken as tablets, skin patches, gels, sprays, or vaginal applications.


3. Testosterone

Testosterone may be prescribed it if you’re post-menopausal and have symptoms such as low libido or fatigue that aren’t alleviated by other forms of HRT. Research is ongoing into whether testosterone could help with other menopause-related symptoms.

How it's taken: Testosterone is typically prescribed as a gel, which is applied to the skin.


4. Tibolone

Tibolone (brand name Livial) is a synthetic hormone that combines the effects of oestrogen, progestogen, and testosterone. It can be an option for women who are post-menopausal, as it may help relieve symptoms such as hot flushes and low mood.

How it's taken: Tibolone is taken as a tablet once a day.


Delivery Methods for HRT

HRT comes in several forms, and the best option for you depends on your lifestyle, preferences, and medical needs. Here’s a closer look at the various methods of HRT:


1. Tablets

Tablets are one of the most common forms of HRT. They are typically taken once a day and come in both oestrogen-only and combined forms.

Advantages: Easy to take, and may be the most straightforward option for many women. Disadvantages: Tablets can increase the risk of blood clots more than other methods like patches, gels, or sprays (although this risk remains small).


2. Patches

HRT patches are applied to the skin, usually on the lower part of your body. They release small amounts of hormones gradually throughout the day.

Advantages: Patches may be a better option for women who struggle with swallowing pills or have trouble remembering to take daily tablets. They also carry a lower risk of blood clots compared to tablets. Disadvantages: Some women find that the patches do not stick well, especially if they use moisturisers or have sweaty skin. Skin irritation or marks can also occur.


3. Oestrogen Gel

Oestrogen gel is becoming an increasingly popular form of HRT. It’s applied to the skin once a day, allowing the hormone to be absorbed gradually.

Advantages: Ideal for women who cannot take tablets, and like patches, gels don’t increase the risk of blood clots. Disadvantages: The gel can take 5 minutes or more to dry, so you need to wait before dressing or engaging in activities that involve contact with the skin.


4. Spray

This method involves spraying oestrogen onto the skin, typically on the inner arm or thigh, once a day.

Advantages: The spray is easy to use, dries quickly, and doesn’t increase the risk of blood clots. Disadvantages: After using the spray, you need to wait for at least an hour before having a bath or shower.


5. Vaginal Oestrogen

For women experiencing symptoms like vaginal dryness, a low dose of oestrogen can be administered directly to the vaginal area. This can come as a cream, gel, tablet, pessary, or ring.

Advantages: Vaginal oestrogen doesn’t carry the usual risks associated with HRT and doesn’t increase the risk of breast cancer. It can also be used without needing progestogen, even if you still have a womb. Disadvantages: This form of HRT does not help with symptoms like hot flushes or mood swings, so it’s only suitable for treating vaginal symptoms.


6. Intrauterine System (IUS)

The Mirena coil, an IUS, is a form of progestogen that can be used in combination with oestrogen HRT. It’s inserted into the womb and gradually releases progestogen.

Advantages: The IUS can stay in place for up to 5 years and also acts as contraception. It’s a good option for women who prefer not to take daily medication. Disadvantages: Some women experience side effects like discomfort or bleeding.


When to Take HRT

The way you take HRT depends on several factors, including your stage of menopause. There are two main types of treatment routines:


Sequential (Cyclical) Combined HRT

This routine is typically recommended if you’re still having periods but are experiencing menopause symptoms. You’ll take oestrogen every day, with progestogen for 10 to 14 days during the month. This form mimics your natural menstrual cycle.


Continuous Combined HRT

Once you’ve gone a full year without a period (post-menopause), you may be prescribed continuous combined HRT. This involves taking both oestrogen and progestogen every day, without breaks.


Final Thoughts

There are many options for HRT, each with its benefits and considerations. The right choice for you will depend on your individual needs, your health history, and your preferences for how the treatment is delivered. It’s important to have a conversation with your GP to discuss the best options based on your situation.

 

Related Posts

See All
bottom of page