Menopause is the phase in a woman’s life which marks the end of menses (periods). After menopause, the ovaries stop releasing eggs and the woman can no longer get pregnant naturally. Usually, a woman goes through menopause around the age of 45-55 years. There are certain symptoms that are seen in the first few years after menopause begins. 

The postmenopausal symptoms involve:

  • Vasomotor symptoms: These symptoms are associated with the dilation and contraction of the blood vessels. These symptoms include hot flashes, flushes, and night sweats.
  • Genitourinary symptoms: These symptoms are associated with the genital and urinary system. One of the main symptoms of menopause is the thinning of the mucus line of the urethra, urinary bladder, vagina and vulva. The other symptoms involve the loss of vaginal elasticity, reduced vaginal secretions making it dry and collapsing of the vessels beneath the mucosa. Some people may also suffer from stress urinary incontinence (leaking of urine on slightest pressure like coughing and sneezing).
  • Bone symptoms: After menopause, progressive bone loss has been reported, which makes them prone to post-menopausal osteoporosis.
  • Psychological symptoms: After menopause, women may suffer from mood swings, insomnia, anxiety, low libido (sex drive) and even depression in some cases. 

Hormone replacement therapy (HRT) is the treatment used to supplement women with hormones like progesterone and estrogen, which are not produced by the ovaries after menopause. 

This therapy helps in relieving the symptoms of menopause by mimicking the hormones created by human therapy. 

Estrogen controls a woman’s reproductive cycle and helps in maintaining the bone density, skin temperature and vaginal moisture. Progesterone helps in maintaining the inner lining of the uterus, which is medically called the endometrium.

Hormone replacement therapy is available in two forms: only estrogen HRT and combination HRT (progesterone with estrogen). HRT can be given in the form of a tablet, gel, rings, skin patches and implants.

Side-effects of hormone replacement therapy like bloating, pain and tenderness in breasts, mood swings and vaginal bleeding makes it less popular among some women. Those who do not want to get HRT can also manage the post-menopausal symptoms by doing regular exercise, eating healthy and quitting unhealthy habits like smoking and drinking. 

  1. What are the types of hormone replacement therapy?
  2. How is hormone replacement therapy delivered?
  3. Who cannot take hormone replacement therapy?
  4. What are the side effects of hormone replacement therapy?
  5. What are the risks associated with hormone replacement therapy?
  6. What are the alternatives to hormone replacement therapy?

The two synthetic (man-made) hormones which are used for HRT are:

  • Estrogen: They are given in the form of estradiol, estrone and estriol.
  • Progesterone: They are given in the form of dydrogesterone, medroxyprogesterone and norethisterone 

There are two types of hormone replacement therapies that are provided to menopausal women:

  • Estrogen-only HRT (only estrogen is given)
  • Combination HRT (Estrogen is given along progesterone)
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Hormone replacement therapy can be given in the form of:

  • Tablets: Both types of HRTs can be given in the form of a tablet which is taken once daily.
  • Gel: Estrogen is available in the form of gels which has to be rubbed on the skin. There are some vaginal gels which are applied inside the vagina to deal with the vaginal dryness.
  • Rings: Rings of estrogen are placed in the vagina to treat the signs of vaginal dryness.
  • Skin patches: A patch is applied on the surface of the skin which delivers either estrogen or both the hormones slowly to the system. The patch is replaced in a few days.
  • Implants: Small pellet is surgically (under anaesthesia) placed under the skin of the tummy, thigh, or buttock, which delivers the hormones for several months before replacement. 

There are some cases in which HRT is totally contraindicated:

  • Women with a history of ovarian cancer or breast cancer are not given HRT.
  • Women who are on blood thinners like aspirin are not recommended HRT.
  • Women with untreated high blood pressure are not given HRT.
  • Women with a blood clotting disorder cannot be given HRT.
  • Women suffering from liver disease are not given HRT.
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There are various side effects of HRT:

There are some major risks associated with HRT:

  • Cancer: Taking hormone replacement therapy for more than a year has been associated with the increased risk of developing breast cancer and ovarian cancer in women. Also, estrogen HRT has been reported to increase the risks of womb cancer, medically called uterine cancer.
  • Blood clots: HRT tablets may form blood clots in the body which can be life-threatening as the clot can block the blood flow. 
  • Heart diseases and stroke: Though the evidence is not enough, the estrogen-only HRT is said to cause heart diseases and stroke in women who start the therapy after the age of 60 years. 
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Due to the side effects, several women do not want to engage in HRT. The alternatives which can be used to manage the post-menopausal symptoms other than HRT are:

  • Regular exercising can help in reducing hot flashes. Yoga and martial art forms like Tai chi would not only improve your health but would also help in reducing anxiety.  
  • A balanced diet rich in calcium and proteins would help you maintain your weight and improve your bone health. 
  • Avoid smoking, caffeine, spicy food and alcohol as they can trigger the hot flashes.
  • Wear loose clothes and try to sleep in a cooler environment to avoid night sweats.
  • Lubricants and soothing gels can be used for vaginal dryness.
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