• Oestradiol, a type of oestrogen is the main hormone in HRT. This is derived from natural yam and is available as tablets, patches, gel or spray.
• Oestrogen patches , gels and spray are directly absorbed through the skin. When given this way, it is termed “transdermal body identical HRT”. This way of taking HRT has a lower risk of blood clots and is recommended for patients with risk factors for clots. Complex cases like these will be discussed with your blood specialist (haematologist) to make sure it is safe to give you HRT.
• The dose of oestrogen must be carefully individualised, and should be taken as advised by a menopause specialist.
• Oestrogen can also be taken as a tablet if you prefer provided you do not have any risk factors for clots or any other medical problems.
• Oestrogen patches are used twice a week, while gel, spray and tablets are taken daily.
• Oestrogen only HRT can only be given to women following hysterectomy (removal of uterus and cervix).
Progestogen is a hormone produced by the ovary and just like oestrogen this declines during the perimenopause. Progestogen is added to oestrogen to protect the womb from cancer, which can occur if oestrogen is given on its own.
• There are several types of progestogens. Natural or Bodyidentical type derived from yam and synthetic type termed Progestins.
• Micronised progesterone is natural, similar to hormones in your own body , and is a Bodyidentical HRT . This has a lower risk of breast cancer , blood clots and is beneficial in patients with certain medical conditions.
• Dydrogesterone is a retro progesterone which has less PMS ( premenstrual syndrome), male hormone side effects and similar benefits of micronized progesterone. In UK this is only available as a combined HRT in a tablet form in different strengths.
• Synthetic progestogens called progestins are available as tablets, patches or in hormonal coils such as the Mirena coil.
For women who have not had a hysterectomy (removal of the uterus/womb) HRT must be given as a combined preparation (oestrogen and progestogen). Adding progestogen prevents cancer of the womb when you take Oestrogen.
Combined HRT can be administered in 2 ways:
1. Fixed dosing: Tablets or patches at a set dose made by the manufacturer that have limited scope for individualisation.
2. Tailor Made: Oestrogen is taken as a patch/gel/spray and progestogen as a tablet/hormonal coil, with the advantage that these combinations can be individualised to suit each patient’s unique needs .
If there are shortages in HRT, a most suitable match of an alternative tailor made HRT can be recommended.
There are two Types of the above mentioned Combined HRT.
• Period HRT (Sequential HRT) is given to women who are still having periods even if they are few and irregular. The main hormone which is oestrogen is given throughout the month and the progestogen hormone is given sequentially for 12-14 days every month to protect the womb from cancer. At the end of the progestogen phase, you will get a withdrawal bleed. Some women who are truly post menopausal may experience no bleeds .
• No Period HRT (Continuous Combined HRT) is given to women with no periods for at least 12 months. This HRT contains oestrogen and progestogen given continuously throughout the month. The woman will have no monthly bleeds but in the first 6 months can have some intermittent spotting which will settle.
