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Menopause - Management
Advice for women before starting HRT

What issues should I discuss with a woman before starting HRT?

  • The risks and benefits of hormone replacement therapy (HRT).
  • The expected duration of treatment:
    • Women with premature menopause usually take HRT up to the age of the natural menopause (50 years); at that time, treatment is usually reassessed.
    • Topical (vaginal) oestrogen may be required long term. Regular attempts (at least annually) to stop treatment are usually made. Symptoms may recur once treatment has stopped.
  • Any possible adverse effects such as breast tenderness or enlargement, nausea, headaches, or bleeding.

What advice should I give about the benefits of HRT?

  • Hormone replacement therapy (HRT) is effective for:
    • Treating vasomotor symptoms (e.g. hot flushes and night sweats).
    • Treating urogenital symptoms (e.g. vaginal dryness, dyspareunia as a result of vaginal dryness, recurrent urinary tract infections, and urinary frequency and urgency).
    • Sleep or mood disturbances caused by hot flushes and night sweats.
    • Preventing osteoporosis. HRT is not normally used as a first-line treatment (as the risks outweigh the benefits) except in women with premature ovarian failure.
    • Reducing the risk of colorectal cancer (but HRT is currently not recommended for this use).

In depth

What advice should I give about the possible risks of HRT?

  • There is a small increase in risk for:
    • Breast cancer: oestrogens may slightly increase the risk of having breast cancer diagnosed. Combined (oestrogen and progestogen) HRT increases this risk by about 1.6 times after 5 years of use and 2.3 times after 10 years of use. Risk decreases within a few years of stopping HRT.
    • Endometrial cancer: increased risk only with unopposed oestrogen. There is no increased risk with combined (oestrogen and progestogen) HRT.
    • Ovarian cancer: long-term use of oestrogen-only HRT and combined HRT may slightly increase the risk. Risk decreases after stopping HRT.
    • Venous thromboembolism (deep vein thrombosis or pulmonary embolism): the absolute risk is small and may be lower with transdermal than oral oestrogen.
    • Coronary heart disease: the increased risk is for women who have started combined HRT more than 10 years after the menopause.
    • Stroke and dementia: found mainly in women over the age of 65 years.

In depth

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