Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) involves the use of hormones to supplement the levels lost during the menopausal transition, aiming to reduce symptoms associated with perimenopause and menopause. 

Most women notice changes in their menstrual cycles in their forties, which often signal the approach of menopause. These changes may include less frequent periods, periods occurring closer together, or heavier bleeding with clots. Common symptoms during this stage are hot flashes, facial flushing, night sweats, headaches, and abdominal pain. Emotional changes, trouble concentrating, migraines, dry skin, or eyes may also occur, along with more frequent urinary tract infections (UTIs) and vaginal dryness, which can make sex painful. Menopause can also affect libido. 

HRT is used to treat moderate to severe menopausal symptoms, usually beginning between ages 45 and 55. Perimenopause refers to the time leading up to menopause, while menopause itself is defined as going 12 consecutive months without a period. The perimenopausal period can last 7 to 10 years, with declining levels of oestrogen and progesterone causing symptoms like irregular periods, hot flashes, and palpitations. HRT helps to alleviate these symptoms by compensating for the body's reduced oestrogen production. 

Although menopause is a natural transition, certain steps can help ease symptoms: 

• Maintain a healthy lifestyle with a diet rich in iron (leafy vegetables and dried fruits). 
• Exercise regularly (30 minutes daily) and keep a consistent sleep routine. 
• Avoid potential hot flash triggers such as caffeine, alcohol, and spicy foods. 
• Wear light clothing or dress in layers to manage hot flashes. Use cotton nightwear and sheets for night sweats. 
• Use vaginal lubricants for dryness and communicate with your partner about any discomfort. 
• Remember that menopause is a normal transition, and it's okay to feel insecure. 

Medication

Doctors can prescribe various types of hormone therapy: 

• Oestrogen-only therapy (monotherapy): Suitable for women who have had a hysterectomy, these medications come as nasal sprays, tablets, patches, or vaginal tablets. They contain oestradiol or oestriol, which are also available in oral forms. 
• Combined oestrogen-progestogen therapy: Used for women who still have a uterus, this combination reduces the risk of endometrial cancer by thinning the lining of the uterus. 
• Tibolone: Effective for symptoms like hot flashes and sweating, with a lower risk of endometrial and breast cancer, though it should be used cautiously. 
• Contraception options: Combined oral contraceptives or intrauterine devices (IUDs) can be combined with oestrogen-only therapy. 

Alternative treatments

Alternative treatments include plant-based compounds (phytoestrogens) that mimic oestrogen, although they may not work for everyone. 

Lifestyle changes

A healthy lifestyle and consistent routines are essential while on HRT. Prioritise rest, reduce alcohol consumption, avoid smoking, eat a balanced diet, maintain a healthy weight, and exercise regularly.