When is hrt started

Hormone replacement therapy HRT is a treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level as you approach the menopause. The main benefit of HRT is that it can help relieve most of the menopausal symptoms , such as:. Many of these symptoms pass after a few years, but they can be unpleasant and taking HRT can offer relief for many women. It can also help prevent weakening of the bones osteoporosis , which is more common after the menopause.

The benefits of HRT are generally believed to outweigh the risks. Read more about the risks of HRT. You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first. A GP can explain the different types of HRT available and help you choose one that's suitable for you.

Like the NICE guideline conclusions, they found that women on combined estrogen and progestogen containing HRT had an increased risk of breast cancer diagnosis but no significant increase in mortality. The Collaborative Group on Hormonal Factors in breast cancer reported that obesity attenuated the absolute and the relative excess breast cancer risk associated with both estrogen only and combined HRT.

Large observational trial data suggest that micronized progesterone and dydrogesterone are likely to be associated with a lower risk of breast cancer compared to that seen with other progestogens.

With regard to cardiovascular risk and HRT, recent data has been reassuring. A large controlled trial from Denmark reported in has demonstrated that healthy women taking combined HRT for 10 years immediately after the menopause had a reduced risk of heart disease and of dying from heart disease.

The Cochrane data-analysis have shown a reduction in cardiovascular events and deaths in women taking either estrogen only or combined HRT within 10 years of menopause or under 60 years of age. Recent evidence from the Collaborative Group on Hormonal Factors demonstrated that there may be a slight increased risk of some types of ovarian cancer associated with HRT use but this is small and equates to around 1 extra case of ovarian cancer per HRT users.

Hormonal status can affect cognitive function and over the years there has been conflicting evidence regarding the risk of dementia and HRT use.

Based on the current evidence, women can be reassured that HRT is unlikely to increase the risk of dementia or be detrimental to cognitive function in women initiating HRT under the age of 60 years. The balance of benefit to harm always needs to be assessed but appears to have shifted favourably for HRT. Users can be reassured provided:. If women start HRT around the time of menopause the risk is very small and there appear to be cardiovascular and bone protective benefits.

It is not usually appropriate for women over 60 to be starting HRT but as the WHI study shows, women initiating it over 60 years do not seem to be at increased risk of cardiovascular events or mortality. For best results, hormone therapy should be tailored to each person and reevaluated every so often to be sure the benefits still outweigh the risks. Hormone replacement therapy primarily focuses on replacing the estrogen that your body no longer makes after menopause.

There are two main types of estrogen therapy:. If you haven't had your uterus removed, your doctor will typically prescribe estrogen along with progesterone or progestin progesterone-like medication. This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of endometrial cancer. If you have had your uterus removed hysterectomy , you may not need to take progestin.

In the largest clinical trial to date, hormone replacement therapy that consisted of an estrogen-progestin pill Prempro increased the risk of certain serious conditions, including:. All of these risks should be considered by you and your doctor when deciding whether hormone therapy might be an option for you.

If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost. You may be able to manage menopausal hot flashes with healthy-lifestyle approaches such as keeping cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxation techniques. There are also several nonhormone prescription medications that may help relieve hot flashes.

For vaginal concerns such as dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief. You might also ask your doctor about the prescription medication ospemifene Osphena , which may help with episodes of painful intercourse. To determine if hormone therapy is a good treatment option for you, talk to your doctor about your individual symptoms and health risks.

Be sure to keep the conversation going throughout your menopausal years. As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change.

If you continue to have bothersome menopausal symptoms, review treatment options with your doctor on a regular basis.

However, oestrogen and progestogens forms of progesterone may stimulate some types of cells in the breast and some types of HRT use have been associated with an increase in the risk of breast cancer in women without a history of breast cancer. It is not recommended that women at high risk of breast cancer , or breast cancer survivors, take highly processed soy supplements which are high in phytoestrogens , but eating moderate amounts of whole soy foods appears to be healthy. Studies have shown that some prescription medications can reduce hot flushes and sweats.

These treatments may be an option if HRT cannot be used for health or other reasons, and should be discussed with a doctor.

The herbal medicine , black cohosh, may take the edge off hot flushes and sweats, but there is no data to support long-term use. There is also a rare liver condition that may be associated with the use of black cohosh. Commercially available vaginal moisturisers such as Replens may reduce vaginal dryness if used regularly. Consult your doctor about what will work best for you. This page has been produced in consultation with and approved by:. Content on this website is provided for information purposes only.

Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.

The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website.

All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances. The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website.

Skip to main content. Hormonal system endocrine. Home Hormonal system endocrine. Hormone replacement therapy HRT and menopause. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. These side effects will usually settle within the first few months of treatment and may include: breakthrough bleeding breast tenderness bloating nausea.

Breast cancer and HRT Women over 50 years of age who use combined oestrogen and progestogen progesterone replacement for less than five years have little or no increased risk of breast cancer.

Cardiovascular disease and HRT Women over 60 have a small increased risk of developing heart disease or stroke on combined oral tablet HRT. Venous thrombosis and HRT Venous thromboses are blood clots that form inside veins.