Hormone Replacement Therapy (HRT)

When a woman enters menopause, the production of oestrogen in the ovaries decreases. This can lead to all kinds of complaints such as hot flashes, perspiration, fatigue, mood swings and listlessness. Depending on the severity of the symptoms, medication in the form of hormones may be prescribed, which is called hormone replacement therapy (HRT). These hormones supplement the content of oestrogen. This reduces or eliminates the symptoms. Treatment is best started at the beginning of menopause. However, there are also some drawbacks to hormone replacement therapy, which is why the benefits and risks of hormone replacement therapy need to be carefully considered in order to make an informed choice that suits you best.

What is hormone replacement therapy?  

Hormone replacement therapy (HRT) is the replenishment of hormones during menopause with the aim of reducing the symptoms associated with menopause. 

What is the cause of hormone replacement therapy? 

The reason for hormone replacement therapy is the complaints that women experience during menopause. The transition usually begins between the ages of 45 and 55. Transition and menopause are often used as synonyms, but menopause is the last menstruation, so we only know this afterwards. The average duration of the transition to menopause is 7 to 10 years. During menopause the production of oestrogen and progesterone decreases, these are the sex hormones. As a result, menstruation follows more quickly, or is absent for longer, and clots are also common during menstruation. This period can give rise to a number of symptoms that are worse in one woman and/or are experienced to a greater extent than in another woman. The most common complaints are hot flashes, perspiration and heart palpitations. In addition, there may be mood swings and fatigue.  

The decline in oestrogen is the main cause of this. To compensate for the decrease in oestrogen levels, hormone replacement therapy (HRT) can be chosen.  

What forms of hormone replacement therapy are there? 

There are various forms of hormone replacement therapy. The hormones can be taken orally (through the mouth) as tablets or capsules, or through the skin with creams or plasters, or pills that are inserted vaginally. There are also ovules for in the vagina or a ring. 

How can you recognise the transition? 

When you are over forty and your menstrual cycle changes, it is usually a sign that you are at the beginning of the menstrual cycle. The periods between menstrual periods may be shorter or longer, your menstrual periods themselves may be shorter or longer, more intense with blood clots. The most common complaints in this phase of your life are hot flashes and sudden heavy sweating and blushing or waking up in the middle of the night bathed in sweat. There may be other symptoms, like headaches and abdominal pain. You may feel more emotional. You may have trouble concentrating. You may experience migraines, dry skin and dry eyes. Bladder infections occur. There may be vaginal complaints such as dryness, which can make intimacy painful. You may also feel less inclined to have sex. All these symptoms can occur to a greater or lesser extent and you can suffer from them to a greater or lesser extent. This is different for every woman and every woman experiences it differently, although there is often a lot of mutual recognition of the complaints.  

What can I do myself about the transition? 

The transition is a natural process. Just like the first time you started menstruating, you are now entering a phase in which stopping menstruation is imminent. There is nothing you can do about this. However, you can do something about the complaints that come with it. Ensure a healthy lifestyle, eat healthily and varied, iron-rich foods such as red meat, leafy vegetables, dried fruits. Do plenty of exercise (at least half an hour a day) and get plenty of sleep. Live regularly. Avoid coffee and alcohol or less during hot flashes, as well as spicy food. Adjust your clothes if you sweat a lot. Cotton clothing. Layers, so you can take things off when you have a hot flush. It is also better to wear cotton clothing at night and use cotton sheets for your bed. In case of vaginal complaints, consider lubrication and a longer foreplay. Discuss it with your partner. Discuss your insecurities with a good friend, sister or doctor. Keep in mind that the transition is a natural phase that can cause different symptoms for each person and that it is normal for you to feel insecure about this. 

What are the forms of treatment? 

There are several medications that a doctor can prescribe you. These are:  

  • Oestrogen hormones (mono-treatment); these are available for women who no longer have a uterus. They contain estradiol. They come in nasal spray, in implantation tablet, in patches and to insert into the vagina (with an applicator the pills are inserted into the vagina). There is also estriol for it in the vagina. There is also an oral form of both estriol and estradiol (to be taken through the mouth). 
  • Oestrogen hormones in combination with progestogens; these are available for women who still have their uterus. The progestogens prevent excessive growth of the endometrium under the influence of the oestrogens.  

For women who want to use contraception (for example for a regular cycle), a contraceptive pill with combination preparation can be chosen. If you are using a hormone spiral, you can combine this with an oestrogen mono treatment. 

  • Tibolon; this medicine only has a beneficial effect against hot flashes and sweat attacks. This medicine is not often prescribed because of an increased risk of uterine and breast cancer. 

 

Alternative treatments 

Alternative treatments exist for menopause, but there is no alternative hormone replacement therapy. Although there are plant substances that resemble oestrogens the phyto-oestrogens, they do not work in everyone equally well. 

Lifestyle changes 

When you have hormone replacement therapy, it is advisable to have a healthy and regular lifestyle. Get enough rest. Reduce your alcohol consumption. Stop smoking. Eat varied. Deal with excess weight. Move enough.  

Additional risks and side effects 

There are risks and side effects of hormone replacement therapy.  

The risks are quite rare, but can be very serious. It will therefore be necessary to weigh up whether the treatment of the complaints you have experienced outweighs these risks. The risks with HRT are blood clots in the legs and/or lungs, liver diseases and gallstones, breast cancer, heart attack and cerebral haemorrhage.  

The possible side effects of HRT are:  

  • nausea, headaches, painful and/or sore breasts; 
  • breakthrough bleeding or more or less vaginal discharge; 
  • swollen ankles and feet due to retaining moisture; 
  • stomach ache; 
  • mood swings; 
  • less inclination to have sex. 

In case of vaginal application: 

  • local complaints such as irritation and itching; 
  • hypersensitivity to the medicine - this can be very serious, in case of tightness and/or swelling in the face (thick lips, mouth, throat, tongue) you should go directly to the hospital. 

Due to the risks and side effects it is advisable to stay under medical supervision. The aim is also to give HRT in the lowest possible effective dosage. 

 

Source 

[Transition]. (z.j.). Consulted on 2018/26/12 at https://www.thuisarts.nl/overgang  https://www.gezondheidsplein.nl/aandoeningen/overgang/item37779 

[Transition Complaints]. (z.j.). Consulted on 2018/26/12 at https://www.apotheek.nl/klachten-ziektes/overgangsklachten#! 

[Treatment of transitional complaints]. (z.j). Consulted on 2018/26/12 at https://www.radboudumc.nl/patientenzorg/aandoeningen/overgang/behandeling 

[How do I recognise transition complaints?]. (z.j.). Consulted on 2018/26/12 at https://www.apotheek.nl/klachten-ziektes/overgangsklachten#hoe-herken-ik-overgangsklachten 

Bouma J, De Jonge, M., De Laat, E.A.T., Eekhof, H., Engel, H.F., Groeneveld, F.P.M.J., Stevens, N.T.J.M., Verduijn, M.M., Goudswaard, A.N., Opstelten, W., . . . De Vries, C.J.H.. 

NHG Standard The transition (first revision). The standard and the scientific justification have been updated with respect to the previous version (General Practitioner Act 2001;44(10):436-45.) General Practitioner Act 2012;55(4):168-72.  

[Medicine]. (z.j.). Consulted on 2018/26/12 at https://www.nhg.org/standaarden/samenvatting/de-overgang#Medicamenteuzebehandeling 

[Medicine]. (z.j.). Consulted on 2018/26/12 at https://www.zavamed.com/uk/hormone-replacement-therapy.html 

[Estradiol to take as available].(z.j.). Consulted on 2018/26/12 at https://www.apotheek.nl/medicijnen/estradiol-om-in-te-nemen?product=estradiol-tabletten#onder-welke-namen-is-estradiol-om-in-te-nemen-verkrijgbaar 

[Estradiol, (mono-treatment)] ; ] (z.j.). Consulted on 2018/26/12 at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/e/estradiol__oraal

[Estradiol/drygesterone] . (z.j.). Consulted on 2018/26/12 at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/e/estradiol_dydrogesteron 

[Estradiol through the vagina]. (z.j.). Consulted on 2018/26/12 at  

https://www.apotheek.nl/medicijnen/estradiol-in-de-vagina?product=vagifem#mag-ik-zomaar-met-dit-medicijn-stoppen 

[Tibolon]. (z.j.). Consulted on 2018/26/12 at 

https://www.apotheek.nl/medicijnen/tibolon#belangrijk-om-te-weten-over-tibolon 

Spiele,T., Biermans, M. Insufficient evidence for phytoestrogens. Consulted on 2018/20/07 at https://www.henw.org/artikelen/onvoldoende-bewijs-voor-fyto-oestrogenen 

Bouma J, De Jonge, M., De Laat, E.A.T., Eekhof, H., Engel, H.F., Groeneveld, F.P.M.J., Stevens, N.T.J.M., Verduijn, M.M., Goudswaard, A.N., Opstelten, W., . . .

De Vries, C.J.H.. NHG Standard The transition (first revision). The standard and the scientific justification have been updated with respect to the previous version (General Practitioner Act 2001;44(10):436-45.) General Practitioner Act 2012;55(4):168-72.  

[Overview of the main absolute risk increases for serious conditions in the use of hormone therapy]. (z.j.). Consulted on 2018/26/12 at https://www.nhg.org/standaarden/volledig/nhg-standaard-de-overgang#Medicamenteuzebehandeling 

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