Latest evidence on using hormone replacement therapy for treating menopausal symptoms

Hormone replacement therapy (HRT) is the most effective treatment for menopausal symptoms, in particular for younger women at the onset of the menopause, suggests a new review published today (19 December) in The Obstetrician & Gynaecologist (TOG).

The review highlights that menopausal symptoms, including hot flushes and night sweats are common, affecting around 70% of women for an average of 5 years but may continue for many years in about 10% of women.

Every woman experiences the menopause differently; some experience one or two symptoms mildly while others have more severe symptoms. Menopausal symptoms can be debilitating and can adversely affect a woman's quality of life.

HRT is a medical treatment for the menopause. It provides low doses of the hormone estrogen, with or without progestogen, which a woman no longer produces.

The review notes that the risk-benefit ratio of HRT has always been debated and discusses previous studies examining the effects of HRT.

The Women's Health Initiative Study in 2003 examined the effect of HRT on healthy postmenopausal women with a particular interest in cardiovascular outcomes. The study reported an increase in breast cancer, stroke and venous thromboembolism. Consequently, an 80% reduction in HRT use was reported. However, the re-analysis in 2007 demonstrated that giving HRT to women within 10 years of the menopause was associated with fewer risks and a reduction in cardiovascular problems.

Some women can use menopausal hormone therapy (MHT) to help control the symptoms of menopause. MHT, which used to be called hormone replacement therapy (HRT), involves taking the hormones estrogen and progesterone. (Women who don't have a uterus anymore take just estrogen.)

MHT can be very good at helping with moderate to severe symptoms of the menopausal transition and preventing bone loss. But MHT also has some risks, especially if used for a long time.

MHT can help with menopause by:

Reducing hot flashes, night sweats, and related problems such as poor sleep and irritability
Treating vaginal symptoms, such as dryness and discomfort, and related effects, such as pain during sex
Slowing bone loss
Possibly easing mood swings and mild depressive symptoms (MHT is not an antidepressant medication - talk to your doctor if you are having signs of depression.)

For some women, MHT may increase their chances of:

Blood clots
Heart attack
Stroke
Breast cancer
Gall bladder disease