How does Hormone Replacement Therapy or HRT work?

HRT stands for Hormone replacement therapy and is used to treat menopause and perimenopause symptoms, such as hot flushes or hot flashes, decrease in sex drive, and brain fog.

HRT is usually made up of oestrogen, progesterone and sometimes testosterone. It replaces the hormones that are lost when an individual's natural levels being to fall due to menopause.

To understand how HRT works, we first need to understand why menopause happens

Medically speaking, menopause is somebody's last-ever period. We say someone is post-menopausal 12 months after their last ever period.

A person will have their last period when they have no eggs left in their ovaries. A woman is born with all the eggs they’ll ever have, and once they reach puberty they start releasing these eggs once a month. When the ovaries are full of eggs, they also release lots of the hormone oestrogen into the body.

In most people, these eggs get released monthly for many years, with the exception of pregnancy and some illnesses or medications.  This means that the number of eggs in the ovaries decreases over time. When somebody becomes peri-menopausal, usually around the age of 40-45, the number of eggs would have depleted quite significantly, and subsequently, the amount of oestrogen released by the ovaries also decreases.

The decrease in oestrogen is what causes menopausal symptoms

Women have oestrogen receptors all over the body; the brain and central nervous system, blood vessels, skin, hair follicles, bones, bladder, vagina and vulva. Over the years, the body and these receptors get used to a certain level of oestrogen and as the levels of oestrogen fall, we see these mental, psychological, sexual and physical symptoms that lots of women experience with menopause.

These symptoms can be quite intense for two or three years in some people and can last up to ten years or more in others. These menopause symptoms can greatly impact a person's quality of life. HRT works by increasing the amount of oestrogen in the bloodstream, which is picked up by these receptors all over the body and therefore makes the symptoms quieten down or go away.

The different types of HRT available to take

There are lots of treatment options. The types of HRT, like gels patches and tablets, go straight into your bloodstream and increase the overall levels of oestrogen in your body, which helps with the symptoms all over the body.

Other types of HRT, like creams, vaginal tablets or vaginal rings are used in or on your vagina, and only have an effect on the area they are used. So, vaginal oestrogen is mainly used to treat vaginal symptoms like dryness, pain, itching or discomfort.

Doctors recommend committing to HRT for around 3 months to feel the full effect

It usually takes a few weeks to feel a difference on HRT. If HRT is the right treatment for you, after your first appointment with a doctor, they will usually prescribe a low dose to start with. It can take a few weeks for your body to get used to the HRT and feel the effects of the medication.

If you don’t feel an impact after the first few weeks or months, you doctor might recommend increasing the dosage you are on or changing they type of HRT you use. The dosage and type of medication you use will depend on the type of symptoms you have, your medical history and type of hormones you require; it’s always best to discuss with your doctor the best course of action for your personal circumstances.

Vaginal bleeding on HRT

In general, postmenopausal women should not experience vaginal bleeding, and should consult their GP if they continue to do so. Although such bleeding episodes are likely benign, it is possibly they indicate a more serious underlying health problem and so should be treated seriously. 

Women on HRT, however, may have an increased risk of experiencing bleeding depending on how it is taken. For example, if you are taking progesterone for 12 days out of the month (known as sequential/cyclical HRT), your menstruation cycle will continue monthly.

By contrast, combined menopausal hormone treatment, which uses both oestrogen and progesterone, is designed to stop vaginal bleeding entirely. Even so, irregular ("unscheduled") or even heavy bleeding episodes are common up to 6 months after starting HRT. If you are concerned about postmenopausal bleeding and unsure as to whether HRT is responsible, this diagram offers a clear and helpful visualisation. You can read our article on bleeding on HRT here.

If you're a Fertifa patient looking to understand more about HRT, get in touch via the app. Our doctors and nurses can talk you through HRT and give you a prescription if they agree it's suitable for your menopause symptoms.