Hormone replacement therapy: your complete expert-led guide

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  • As Davina details her own HRT routine.

    Ever heard of hormone replacement therapy? If you watched Davina McCall’s Sex, Myth and the Menopause, you’ll have seen the singer detail her own experience with the treatment.

    HRT has had a mixed rap over the years – while Canadian researcher James Bertram Collip discovered a way to extract estrogen from the urine of pregnant women in the 1930’s, it was only in the 1960s that premarin – an estrogen derived from the urine of pregnant mares – was used for menopausal hormone replacement. “It was proclaimed “the new fountain of youth””, explains Dr Ghazala Aziz Scott of the Marion Gluck Clinic.

    While HRT has evolved over the decades and evaluated through research and clinical trials, it’s still sometimes shunned thanks to a 2002 study which warned of the raised risk of breast cancer.

    FYI, the average age for the menopause in the UK is 51 and is defined as the absence of menstruation for 12 months, but the period leading up to the this is called the perimenopause and can last for many years. We now understand that the transition into menopause is a gradual process and women can have a rollercoaster ride of fluctuating hormones that can really impair their quality of life,” shares Aziz Scott.

    Here, doctor Aziz Scott explains what hormone replacement therapy is, how it works, what the common side effects are and how to know whether it’s the right option for you.

    Hormone replacement therapy: your guide

    What is HRT? 

    HRT is a treatment – commonly a tablet or skin patch – that works by replacing the hormones that decline during the menopausal period, shares Aziz Scott. “This is most commonly estrogen and progesterone, however it has now been recognised that testosterone replacement is also important in women in low doses, too,” she continues.

    By doing so, you ease menopause symptoms by replacing the hormones that naturally decline with age.

    Why is this important? Simply put, because each of our hormone has a specific function and further, symptoms related to its deficiency. “For example, estrogen deficiency causes hot flushes, night sweats, and vaginal dryness,” shares the doctor.

    “Progesterone deficiency links in with insomnia and anxiety while testosterone replacement will improve energy and libido. Plus, all of these hormones are neurosteroids and can have an impact on brain function, specifically memory – a common menopausal complaint.”

    Are there different types of HRT?

    Yes, there are. According to the NHS website, because there are so many types of HRT, finding the right one for you can be somewhat difficult.

    They span:

    • Tablets
    • Skin patches
    • Gels
    • Vaginal creams
    • Pessaries
    • Rings.

    Side effects of HRT

    Side effects relating to estrogen replacement can be:

    Those relating to progesterone can be:

    • Fluid retention
    • Mood swings.

    Similarly, testosterone can cause:

    However, with the correct regime to suit your needs, side effects last only a few weeks, shares Aziz Scott. “Symptoms can be minimised,” she reassures.

    I’m not sure whether I should take HRT – help! 

    Short answer – it’s up to you. “Most women notice a huge improvement in quality of life with HRT with fewer symptoms, improved hot flushes and night sweats, improved sexual health and libido and better mood,” shares Aziz Scott. “There are also well researched long term health benefits such as decrease in osteoporosis risk, improved cardiovascular health and a decreased risk of Alzheimer’s dementia.”

    Bottom line: the doctor reckons that the benefits of HRT usually outweigh the risks for most women. “The risks are usually small, depend on the type of HRT you take, how long you take it for and your own health risks,” she goes on.

    Hormone replacement therapy: Gels

    Can HRT cause breast cancer? 

    Thanks to the 2002 study, women often worry about the risk of breast cancer. So what does the doctor reckon? “Recent research shows there is little or no change in risk of breast cancer if you take bioidentical or bodyidentical estrogen and progesterone,” she explains.

    “In fact, other risk factors such as obesity, lack of exercise and smoking have a greater impact,” she warns. “But regular breast screening to check for breast cancer is vital.”

    Davina’s HRT routine: oestrogen patches and more

    Sharing her morning HRT routine on Instagram, Davina detailed the gels, creams and patches that she uses post-shower every day. “A big part of my morning routine is my hormones and I thought to demystify it a little bit I would show you how you apply them,” she says.

    Talking about her menopause documentary, she says: “I don’t think I’ve ever worked on a project that has affected me so deeply. She said that she regularly got choked by “deep frustration and anger at how we are failing women. This film isn’t just for menopausal women, it’s for their partners, their fathers, their brothers, and their sons. We’re all in this together. I used to think that menopause was an age thing and now I realise it’s a woman thing. For far too long, there’s been a shroud of embarrassment, shame and fear around this topic, and this is where it stops!”

    Her usual routine includes:

    1. An oestrogen patch 2x a week

    The first thing you see Davina apply is remove a clear “hormone sticker” on her hip called Estradot. She replaces the small plaster twice a week. “It does leave a bit of sticky stuff [like any plaster] but I thought you should see the ups and downs. I wanted you to see it warts and all.”

    She switches hips when she replaces the sticker. “We use stickers because they are transdermal [absorbed through the skin as opposed to a tablet] Transdermal is important because it’s a much better way to take HRT,” she shares.

    FYI – the patch is translucent “so whatever skin colour you are it goes clear,” or so she reassures.

    2. Oestrogen gel – daily

    Davina also uses a clear transdermal gel called Oestrogel. She applies it by rubbing it into her upper arm and does so to boost her oestrogen levels.

    Fun fact: “Oestrogen these days is plant-based,” or so says Davina.”It’s made from yams. They are very, very different from the hormones that were taken back in the day.”

    3. Testosterone cream – daily

    Next, Davina rubs a Testosterone cream into her thigh, but Davina shares that this particular hormone is less commonly prescribed and not widely available via prescription on the NHS.

    “I think you can get this if your libido is on the floor,” shares the presenter. “But this is more than just about sex drive. Did you know that testosterone is an enormously important women’s hormone as well? My testosterone was low and I take a pea-sized amount.”

    “By the way, taking testosterone does not make you or a penis or testicles or get hairy or anything like that. I am not taking extra testosterone I am just replenishing my levels to where they should be.”

    4. Progesterone – coil

    As we’ve explained, most hormone replacement therapy combines oestrogen and progestogen. While many women take a progesterone pill called Utrogestan, Davina doesn’t as she has a coil which provides it. “The progesterone part of my HRT, I get from the Mirena coil,” she shares with her followers.

    On her daily routine, she says: “I know you must think it’s a faff, but I do feel normal again and dare I say sometimes I feel better than I have done in years and years. So for me, the faff is worth it.”

    Considering trying HRT yourself? Aziz Scott advises you seek medical advice from your GP – ideally one who has expert knowledge in the menopause, she shares. “Remember to ask for bodyidentical or bioidentical HRT, as we know this is the best option. Vaginal estrogen creams are also very helpful for vaginal health and can be used safely,” she concludes.

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