Frequently Asked Questions
- Q. Will I put on weight if I take HRT?
A. This is the MOST frequently asked question. Studies have shown that as many women gain weight that are NOT taking HRT as those that are. Unfortunately, many women do gain weight around the time of the menopause and HRT should not necessarily be blamed for this. Some women taking HRT have exacerbation of fluid retention, which is closely related to weight gain. Changing the dose or route of HRT can often help.
- Q. How long can I take HRT for?
A. HRT can be taken for as long as the individual wishes, as long as she understands the pros and cons and for herself, balances the risks against benefits. If purely taken for control of menopausal symptoms, it is worthwhile having a trial off treatment every few years to see if the symptoms are still present. HRT can then be recommenced if the symptoms recur. If HRT is being taken for bone protection, then longer-term treatment is preferred. HRT taken for more than 5 years after the age of 50 is thought to confer a small increased risk of breast cancer so with long-term treatment, this risk must be balanced against the benefits for each individual.
- Q. If periods have stopped for some time, would HRT cause periods to return?
A. If it is known that the periods have stopped by having at least 1 year without periods, "period-free" HRT can be offered. In this, estrogen and progestogen are both given daily (either by tablet or patch). With daily administration of both hormones, the lining of the uterus remains thin. Although some bleeding in the first few months is common, this usually settles and monthly withdrawal bleeds do not occur.
- Q. I've been taking a "period-free" HRT for
4 months and am still having some occasional bleeding. Does this matter?
A. On this type of HRT, bleeding may take 6 months to settle. As long as the bleeding is light, it is worth persevering. Investigations are not needed unless bleeding is heavy, persists beyond 6 months, or occurs at a later stage after a spell of no bleeding.
- Q. Do I have to stop HRT before going on a long flight?
A. There is thought to be a small risk of HRT causing a blood clot in the first year of use. Therefore, if you’ve not had any problems by now, it is unlikely to cause problems. Long-haul flights may increase the risk because of the long periods of immobility. Therefore it is important to keep moving your feet and legs as much as possible and drink plenty of water or decaffeinated drinks, avoiding alcohol and coffee. Leg exercises are now usually shown in the in-flight magazines and can be carried out easily: these will include circular foot movements by rotating the ankles; pointing your toes away from the leg and then pulling your foot up towards the shin; and simply going for occasional walks up and down the plane during the flight. Try to avoid sitting with crossed legs or ankles. Some people advise taking a single small-dose aspirin before travelling to keep the blood thinner, but some people cannot take aspirin because of other medical problems. Flight stockings help to keep the circulation moving but you should check that they fit properly and are not too tight.
- Q. For how long do I need to use contraception?
A. The question of how long, or up to what age is contraception required is often the cause of uncertainty and confusion. As a general rule, if the periods stop below the age of 50, then contraception should be used for a further 2 years. If the periods stop after 50, then 1 further year of contraceptive use is advised.
If HRT causing a monthly bleed is commenced before the periods have stopped, it can be very difficult to know when your own ovarian function has stopped. In this case, if it is decided to continue HRT, an arbitrary age of 54 can be taken as the age at which contraception can be discontinued, though many women will choose to stop using contraception before this age. It is often thought that if the ovarian function has declined such that HRT is required, then egg production and hence fertility is unlikely. However, varying and late egg production is possible. It should be noted that HRT in usual doses does not suppress ovarian function and is therefore not contraceptive.
The type of contraception used depends on the preferences and circumstances of the individual. Barrier methods, progestogen only pill and intra-uterine devices are often used very effectively at this stage, and low dose combined oral contraceptives can be used in fit, non-smoking women up to the menopause.
Breast cancer related
- Q. Can HRT be taken if there is a family history of breast cancer?
A.A close family history of breast cancer can increase the individual's risk of developing breast cancer, particularly if the family member was affected at a young age. HRT taken for short-term (<5 years) for control of menopausal symptoms, is very unlikely to increase this risk further. HRT taken for >5 years, is thought to be associated with an increased risk. If this is combined with the risk from the family history, the individual may feel that the benefits of long-term HRT are outweighed by the risk. For each individual, the risks must be balanced against the benefits.
Q. I had breast cancer a few years ago. I’m now having awful
flushes and sweats. I’ve been told that I can’t have HRT but
is there anything else that I can take?
A. Firstly, for anyone having menopausal symptoms, it is worth thinking if any diet or lifestyle changes are required; stopping smoking, reducing alcohol, reducing caffeine, healthy diet and increasing exercise can often help. If specific treatments are needed, there are a range of non-hormonal drugs which have been shown to reduce flushes and sweats to some extent, and would be worth discussing with your doctor.
Alternative therapy related
- Q. Are there any dietary or natural alternatives to HRT?
A. Estrogenic activity can be found in naturally occurring products called phytoestrogens and are mostly found in cereals, soy, legumes and some grasses such as red clover. They can be taken in dietary or supplementary form. Research on the effect of these products is scarce but does suggest some beneficial effect on menopausal symptom control. Further information is required to clarify the effects, particularly on bone, breast and uterine lining. Herbal remedies such as Don Quai, Ginseng, St.John's Wort and Black Cohosh have also been used for menopausal symptom control, but again information about their specific effects is lacking.
Page last updated: 6 December 2011