Dear doctor, I think I’m going through menopause. Can I have HRT and is it safe?

13 November 2018

I’m 49 and I think I’m going through menopause. I have hot flushes, night sweats and irregular periods. I’m also experiencing vaginal dryness which makes it difficult to have sex with my partner. Can I have HRT and is it safe?

I would agree that you’re probably going through the menopause. The average age in the UK is 51, but there can be much variation.

The menopause means ‘cessation of periods’, and while periods will eventually stop, initially they can become irregular or infrequent. Any bleeding between periods or after sex should however be investigated to rule out abnormalities of the womb or cervix and sexually transmitted infections.

Some women will have very few menopausal symptoms whilst others may experience:

  • Drenching night sweats
  • Hot flushes
  • Mood changes
  • Disturbed sleep
  • Lack of libido
  • Poor concentration
  • Generalised aches and pains
  • Vaginal dryness

Vaginal dryness can lead to difficulties with penetrative sex and recurrent urinary tract infections. These symptoms are believed to be related to the natural decline in oestrogen produced by the ovaries. For most women with few or manageable symptoms, no treatment is needed. However, women under the age of 45 may be required to take a blood test as menopause below this age is considered premature. The diagnosis over 45 is based on symptoms alone.

It’s important to note that women can still be fertile during the ‘perimenopause’ - the time around menopause. I would recommend additional contraception if pregnancy is not desired.

With most HRT, women take a combination of the hormones oestrogen and progestogen. An effective method of providing HRT and contraception simultaneously is the Mirena intrauterine system as it provides progesterone and can be used with a gel, patch, or oral form of oestrogen.

If vaginal dryness is the main issue, a relatively low risk option is topical oestrogen - either as a pessary, cream or vaginal ring. Topical oestrogen is used for 3-6 months and may take this long to become effective. Further courses can be used long term if needed. Vaginal lubricants can also be used, which do not contain hormones.

With regards to the risk of HRT, the subject of much controversy over the last few years— current evidence suggests that HRT given to symptomatic women around the time of menopause for less than 10 years is of relatively low risk.

Find out more about, Dr Siobhan Gill, private GP practising at Spire Portsmouth Hospital.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.

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