Back to all resources
Before we dive into the nitty gritty of HRT, some recommended reading first:
What is HRT?
A Better Understanding of Menopause Symptoms
The Link Between HRT and Breast Cancer
What ways can I take HRT?
There are a number of different ways HRT can be taken;
Oral – By mouth (tablets)
Transdermal – Via the skin (gels, patches, sprays)
Vaginal /Topical - Into the vagina/ around the vulva & vaginal area (pessaries, creams, vaginal rings)
Subcutaneous – Into the fatty tissues of the skin (Implants)
Different regimens for taking HRT
Continuous combined HRT: This is when both oestrogen & progestogens/progesterone is taken together every day. This way of taking HRT is usually for women who are post-menopausal i.e. have not had a period for more than 1 year.
Sequential HRT: This is when HRT is given in a way to induce a bleed. Usually, oestrogen is taken for the first 2 weeks of the cycle, and then a combination of oestrogen and progestogen/progesterone is taken in the last 2 weeks of the cycle. This regimen is for women who are not yet post-menopausal.
Oestrogen Only HRT: This is when only oestrogen is given every day. This is only given to women that do not have a uterus (have had a hysterectomy).
Mirena LNG-IUS: Otherwise known as Mirena coil. This is an intrauterine system, containing levonorgestrel (synthetic progesterone). This is a great option for women who need contraception and/or have heavy periods/heavy withdrawal bleeds from HRT, or for those who have adverse effects from a tablet or patch containing progestogen. The Mirena coil can be used for up to 5 years for HRT.
As with any medication, there can be risks associated with taking HRT, and there are reasons why certain routes are recommended for some people. These are explained below.
Risks Associated with Taking HRT
Oral HRT and risk of blood clots - Venous Thromboembolism (VTE), Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
With oral HRT use, there is a slightly increased risk of having a blood clot and the risk is mainly linked to age. This risk of blood clots is thought to be greater within the first year of use, women who are older and have an increased body mass index are at higher risk of having a blood clot.
Women who have had a blood clot or have a family history of blood clots may be denied HRT due to the increased risk. Usually, these women are seen by a specialist menopause service, sometimes they may be prescribed Transdermal HRT if it is considered safe to do so.
Oral HRT will usually have the days of the cycle printed on the pack. With continuous combined therapy all of the tablets in the pack are the same. If you are prescribed Sequential therapy there are to different coloured tablets, again the pack will have the days of the cycle printed so you know when to take them.
Transdermal HRT
There is said to be little or no increased risk of having a blood clot with transdermal HRT. In women who are older and women who are very overweight, the risk of blood clots increases. Special consideration is given when prescribing HRT and a transdermal preparation is usually recommended in this group.
Women with coeliac disease or digestive problems should avoid oral HRT as it passes through the gut and will not be absorbed effectively. Transdermal HRT should be recommended in this group of women as it is absorbed through the skin.
When using HRT patches, the skin must be clean, dry and free from any creams etc so the patch can adhere to the skin effectively. Patches release a measured dose of hormones in a 24-hour period, so changing the patch more frequently than prescribed will not give you more hormones.
Gels are usually rubbed into the skin using the fingertips, again it’s important to keep the skin clean and dry to ensure the gel is adequately absorbed. Do not shower within an hour of application as you will wash away the treatment. You must make sure that you do not touch anyone with gel on your hands and thoroughly wash and dry your hands after application.
Always follow the manufacturer’s guidance as to where to apply the treatment as they can vary.
Vaginal or Topical oestrogen
These are a very low dose of oestrogen and can be used in isolation to treat urogenital (vaginal &/or bladder) symptoms (Vaginal dryness/soreness/ frequency of urine/recurrent urine infections). They can also be used in addition to Oral/transdermal HRT if required.
The pessaries and creams come with an applicator so the medication can be effectively inserted into the vagina. When starting treatment, it is usually applied daily for the first 2 weeks, then a maintenance dose of twice weekly thereafter. This can be used on a long-term basis as symptoms usually return when treatment is stopped.
Vaginal rings are flexible rings, around the size of a 50-pence piece which is inserted into the vagina. The ring should be changed every 3 months and can only be used for up to 2 years.
Subcutaneous HRT
Oestradiol Implants are used as a last resort, usually when all other routes of Oestrogen therapy have not worked. You will need to be seen at a specialist menopause service to have an implant. Implants are inserted into the fatty tissues of the abdomen or buttock by making a small incision and burrowing the implant into the fat. Sutures or steri-strips seal the incision. Regular blood tests need to be taken when having implants and they usually last 6-12 months.
Mirena LNG-IUS: Needs to be fitted by a healthcare professional, some GPs/practice nurses will fit them. Contraception services will fit them if it is being used for contraception. Some women experience abnormal bleeding such as spotting for a few months after having the Mirena coil fitted. Many women do not have periods with the Mirena coil which is a blessing for many women especially if they have been suffering with heavy periods. If you are considering a Mirena IUS it is advisable to take some pain relief prior to having it inserted. Make sure that you have not had any unprotected intercourse in the cycle leading up to your appointment. If you are having a Mirena IUS replaced, you should not have any intercourse in the 7 days before your appointment. The Mirena IUS cannot be inserted if there is a risk of pregnancy.
A gentle reminder however, that you do not necessarily need to take HRT for menopause. There are many lifestyle factors which affect how you experience menopause, and there are also non-HRT alternatives.
Lifestyle Factors to Help with Menopause Symptoms
Non-HRT Alternatives for Menopause
Similar articles
The impact of menopause on relationships
This article will look into the impact that menopause has on relationships.
Read post
Managing Brain Fog Caused by Menopause
If you're suffering from brain fog because of menopause, here are some top tips on how to relieve this common menopausal symptom.
Read post
Bone Health During Menopause
This article details what causes lower bone health during menopause, helps you understand why you're at risk of developing poor bone health during menopause and some tips to improve bone health during menopause.
Read post
Menopause and Mental Health
In this article we look at the impact menopause has on mental health, and things we can do to help.
Read post
