FAQs

What should I expect at my first appointment?

At your first visit to the clinic, the doctor will obtain your medical history, discuss symptoms/health concerns and agree a treatment plan with you.

We will arrange any relevant blood tests or scans if you need them. If you require a referral for specialist treatments such as Mirena coil insertion or hysteroscopy, we will organise this for you.

What is Hormone Replacement Therapy (HRT) and why do I need it?

HRT is medication aimed at relieving the symptoms that some women experience during the menopause, also known as the change of life. Common symptoms include hot flushes, night sweats, vaginal dryness, tiredness and irritability, and decrease in sex drive.

HRT works by replacing the hormone (oestrogen) your body stops producing when you go through the menopause or when you have had surgery to remove your ovaries.

Used long-term, HRT may help to reduce the risk of osteoporosis (thinning of the bones) and bowel cancer. However, there are also known risks including an increased risk of certain types of cancer. These risks are described in more detail here and will be discussed with you in your clinic appointment.

Watch video on HRT and heart - HRT Heart

Watch video on HRT and brain - HRT Brain

When you start HRT, the doctor will discuss your age, symptoms and medical conditions before looking at the risks and benefits of HRT which are specific to you.

HRT - what are the benefits and risks? Watch some of the videos of our talks by clicking the link HRT

What are the different types of HRT?

There are two different types of HRT:

Oestrogen only (no progestogen) - when women have had a hysterectomy, they do not need progestogen to protect the lining of the womb.
Combined HRT (oestrogen and progestogen) - this is necessary if you still have your womb. This can be given in two ways:
- Continuous combined HRT - oestrogen and progesterone, taken together daily (one a day) for 28 days, this means that there will be no withdrawal bleeds.
- Sequential HRT - oestrogen only for the first 14 days then both hormones for the second 14 days. This usually results in monthly withdrawal bleeds.

The type of HRT you take will depend on where you are in the menopause and if your periods have stopped completely for a year.

How long does HRT take to work?

It usually takes a few weeks before you will feel the initial benefits of HRT and up to three months to feel the full effects. It may also take your body time to get used to HRT. When treatment begins you may experience side effects such as breast tenderness, nausea and leg cramps. Usually these side effects will disappear within six to eight weeks. If they do not, a change in the type or dose of HRT may be necessary and your own doctor will advise you on this. If after four to six months of HRT, you have not felt the benefits of the HRT it may help to try a different type.

How do I take the medicine?

This depends on the type of HRT you are taking (oestrogen only or combined) and does not always mean tablets. The different types, or ‘preparations’, of HRT are:

Patches

HRT patches can contain oestrogen, alone or with progestogen. They are applied once or twice a week to any area below the waist. They are effective in relieving both short-term symptoms and, if taken for longer, the long-term complications of the menopause.

HRT tablets

A wide range of tablets are available, and they are taken once a day. They can contain oestrogen or a combination of oestrogen and progesterone. They are effective in relieving both short-term symptoms and, if taken for longer, the long-term complications of the menopause.

HRT gel or spray

Oestrogen is also available in the form of a gel or spray. It is applied once a day to a clean, dry, unbroken area of skin, usually on the upper arm, shoulder or inner thigh. It is rubbed in and takes a few minutes to dry.

Progesterone

If you have a womb then you will also need to have progesterone to protect the womb lining. This can be in the form of either capsules or Intra Uterine System (IUS) Mirena coil.

Implants

Oestrogen and testosterone can be administered via implants inserted beneath the skin.

Vaginal oestrogen (local HRT)

Vaginal creams, vaginal tablets, vaginal rings or vaginal pessaries contain a small amount of oestrogen and only work for specific symptoms where they are applied, such as vaginal dryness and urinary symptoms. Local HRT will not improve other symptoms such as hot flushes, or protect against the longer-term effects of the menopause such as osteoporosis. Local HRT does not have the same increased risks as other types of HRT so can be used by most women.

What should I do if I forget to take the medicine?

If you forget to take your HRT do not take the doses that you have forgotten, just take the next dose when you remember.

Are there any side effects?

Many women experience side effects in the first few months of taking HRT. If problems persist after three months of treatment then the type of HRT may be changed. Women react differently to HRT, so there is no one preparation that is better than any of the others. It is often a personal choice as to the type of preparation we try first.

Weight gain

It has been scientifically proven that women gain weight during the menopause, so any weight gain may not be a result of HRT. Your body’s fat distribution also changes, with an increase in fat around the waist and less around the hips and buttocks. You can also experience water retention when on HRT. If this happens then it may be worth trying a different preparation of HRT.

Blood pressure

There is no evidence that blood pressure increases with taking HRT in most women. Women are advised to have their blood pressure checked and treated in the usual way.

Bleeding

Irregular bleeding in the first few months of taking any form of HRT is quite common and usually settles. Any bleeding after the first six months will need to be investigated with ultrasound scans and possibly a hysteroscopy (where we look inside the womb, through the vagina, using a small telescope at the end of a narrow tube).

Nausea

Some women complain of nausea associated with HRT. This can be reduced by taking the HRT tablet at night with food instead of in the morning, or by changing from tablets to another type of HRT.

Skin irritation

This can happen with patches and occasionally gel. Sometimes the patches may fall off.

Other side effects

Other side effects that can occur and normally settle include: breast tenderness and enlargement, leg cramps, bloating, headache, pre-menstrual symptoms, lower abdominal pain, backache, depressed mood, acne/greasy skin.

Are there any risks?

The information leaflets contained in the HRT packages can be misleading. Please click here to find out details

How long should I take HRT for?

If HRT is being taken solely for the relief of menopausal symptoms, it should usually be taken for up to five years. To obtain the best benefit in reducing the risk of osteoporosis, HRT needs to be taken for a minimum of five years. For women who have had an early menopause visit Premature Menopause Clinic London or surgical removal of the ovaries, the time is not counted until they have reached the age of 50 (the average age of the menopause).

All discussions about stopping or decreasing the amount of HRT you take should be had with your doctor. Yearly review of benefits versus risks should be undertaken.

I have been diagnosed with premature menopause - Can I have a baby?

We understand that you must be extremely distressed with the news that you have attained premature menopause and that you may not be able to start your own family. Your own eggs have indeed been exhausted, but there are now ways around this. While adoption is one approach, more and more women like you are resorting to egg-donation IVF. Please visit Premature Menopause Clinic London for more details on how we can help you.

How do I get a repeat prescription?

You can get a repeat prescription from your GP or you can contact us .

What are the alternatives to HRT?

If you are unable to have HRT, other medications or treatments may be prescribed to help control your menopausal symptoms. For vaginal dryness and painful sex – vaginal lubricants and moisturisers are often effective. For hot flushes and night sweats – antidepressants or selective serotonin reuptake inhibitors such as Venlafaxine, Gabapentin, Oxybutynin, NK3R antagonists and Clonidine (blood pressure lowering agent) are oral medications which are most commonly prescribed. Alternative therapies including homeopathy and acupuncture are also offered at specialist clinics. Testosterone gel is prescribed by some clinics to improve libido. The evidence for effectiveness of these medications is limited but many women chose these options to avoid the risks associated with HRT. If you wish to consider any of these alternatives, you should talk to your doctor in details about the risks versus benefits of these treatment options and make an informed choice.

Tibolone (brand name Livial) is another type of hormone treatment, but it does not contain oestrogen or progesterone. You can start taking it at least one year after your periods have stopped, you should not get any monthly periods. If you take tibolone, you are likely to have half as many hot flushes, less vaginal dryness, improved sexual satisfaction and more sexual arousal. Researchers have found that sex drive increases much more in women taking tibolone than in women taking combined HRT. Tibolone may slightly increase your chance of breast cancer, but less than if you take combined HRT.

Phyto-oestrogens are chemicals that are found in some plants. They act like a weak form of oestrogen. Soya products such as tofu and miso are rich in phyto-oestrogens, as are beans, lentils, certain fruits and celery. You can also get over-the-counter supplements such as red clover pills from some pharmacies and health food shops. The research into phyto-oestrogens is not as robust as that for HRT. Most of the research suggests that they do not help reduce hot flushes. Phyto-oestrogens also probably do not help with the sexual problems or bladder infections linked with the menopause. Because phyto-oestrogens act like oestrogen in the body, it is possible that they could increase the chance of breast cancer and cancer of the lining of the womb (endometrial cancer). But there is not enough good research to say whether this happens or not.

Black cohosh is a popular herbal treatment. You can buy products made from black cohosh from health food shops. Most good quality research suggests that black cohosh does not make much difference to hot flushes. Some people taking black cohosh get stomach pains.You might also feel dizzy and nauseated, and get headaches when you take it. Black cohosh may cause liver problems in some women. You should always tell your doctor if you are taking herbal treatments as they can sometimes react with treatments your doctor may prescribe.

A review of current scientific literature suggests that there is evidence for positive impact of acupuncture on several menopausal symptoms including hot flushes, sleep disturbances, and mood swings. Similarly, there is some evidence to support the use of yoga therapy to treat hot flushes, sleep quality and stress.