FAQs

No, HRT does not delay menopause. Menopause is a natural process which a reflection of ovarian ageing. HRT helps with the symptoms of menopause.

There are different ways in which HRT can be taken. The different delivery routes may be recommended to take one form of HRT over another. Personal choice also comes into play regarding the option to be used.

1. Transdermal (patches or gel through the skin) - This is a bioidentical form of oestrogen, which is the safest option for its administration. It has the same structure as the oestrogen we produce in our bodies. Transdermal oestrogen has the advantage of being absorbed through the skin and thus avoids being broken down in the gut and the liver. It, therefore, has the lowest risk of blood clots. The patches come as oestrogen only or as a combined patch with progesterone. They are usually applied twice weekly. The spray and gel forms are oestrogen only and would require separate progesterone if a woman has a womb (and therefore needs both oestrogen and progesterone). The spray and gel are applied daily.
2. Progesterone
   • Transdermal - Progesterone can be given in patches through the skin in combination with oestrogen.
   • Oral tablets - Progesterone is available in tablet form. These tablets can be pure progesterone or in combination with oestrogen.
   • Intrauterine device - Progesterone can be given straight into the womb via an intrauterine device-Mirena coil. This can be used for five years as part of HRT and provides contraception simultaneously. This option has fewer side effects than other synthetic progestogens in the patches or tablets.

Yes, this happens regularly. If a woman starts a regimen, we advise staying on this for a while before changing to a different one.

If HRT with regular bleeding is started, we recommend a minimum of one year before changing it to a continuous regimen.

Side effects of testosterone gel include increased hair growth at the application site; advice will be given to prevent this.

If you are experiencing side effects such as weight gain, acne, deeper voice or hair loss at the front area of your head, please contact your doctor for advice. All side effects should be discussed with you before you start taking testosterone.

Testosterone is an essential female hormone, which is typically much higher before menopause as opposed to menopausal years. Testosterone replacement often has a very positive impact on libido. Although evidence is limited, many women find that testosterone helps improve energy levels, mood, and concentration.

We would recommend a woman is stable on an HRT regime before starting testosterone. NICE guidelines advise prescribing testosterone in cases where women experience distressing low libido.

Please contact the team if you would like more information.

Yes. Please call or email us to arrange an appointment to discuss Mirena coil fitting.

1. Breast cancer - Current research suggests that depending on the type of HRT used, HRT taken for five years or less has little to no increased risk of breast cancer. After this time, the risk of breast cancer increases the longer you take HRT. Oestrogen alone and combined HRT using oestrogen and micronised progesterone have no increased risk (oestrogen alone has been shown to reduce risk). Combined HRT with a progestogen has a minimal increased risk over five years. After five years, the risk of all combined HRT has a slightly increased risk of breast cancer. This risk is no longer there after stopping the HRT.
2. Blood clots - Tablet form of HRT has been related to a slightly increased risk of blood clots. This must be considered with other risk factors such as smoking and BMI. Benefits and risks must be carefully discussed; sometimes, a transdermal preparation may be suggested instead. Transdermal oestrogen would be suggested if there is a medical history of increased risk of blood clots or a family history. There is good evidence that transdermal oestrogen does not increase clot risk. Some progestogens have a higher risk for blood clots than others, which may also need to be considered when prescribing HRT.
3. Ovarian cancer - No reliable studies have been published on the risk of ovarian cancer with HRT, but one study showed a minimal increased risk of 1 in 2,500. Other studies have not demonstrated an increased risk.
4. Heart disease - There is a controversy regarding HRT and heart disease. Available evidence suggests that there is a ‘window of opportunity’ where HRT is beneficial for the heart (within ten years of menopause or < age 60). After this, the effect will likely be neutral on the heart rather than harmful. However, in women who have unstable cardiovascular disease, HRT is contraindicated until the heart disease is ‘stable’ and, even then, may require discussion with a heart specialist if HRT is considered.
5. Endometrial cancer - HRT has a minimal increased risk of endometrial cancer if given for over five years.

Refrain from taking the missed doses; continue to take the next dose when you remember.

Breast tenderness is a common early side effect due to either the oestrogen or the progestogen component of your HRT. These symptoms often settle in time. We always advise all our patients to have regular mammograms, be breast-aware, and self-examine regularly.

It is common to experience some irregular or heavier bleeding when starting HRT. It can also happen when the dose is changed. This can take 3-6 months to settle. If symptoms persist or worsen after this time, we recommend a review appointment at Abbey Menopause or with your GP as further investigations may be needed.

Current NICE guidelines state that there is no maximum or minimum time frame for a woman to continue taking HRT.

Every case is unique, and the length of treatment will need to be considered individually.

Guidelines suggest an annual reassessment of HRT to provide safe prescribing and to discuss the risks and benefits of taking HRT for you.

At the start of treatment, mild side effects such as breast tenderness, nausea, bloatedness, skin irritation, and irregular bleeding may be experienced. These symptoms usually disappear within 6-8 weeks of starting treatment. If they do not improve, then a change in treatment may be necessary.

Most women feel the benefits of treatment after just a few weeks. It can take up to several months to see the full benefits.

Body-identical HRT or regulated bioidentical HRT is the safest form of HRT, with the lowest risk of side effects. This is what we prescribe at Abbey Menopause. These hormones are structurally identical to the natural hormones we produce in our bodies.

The British Menopause Society and NHS do not recommend compounded bioidentical hormones. These hormones are not regulated, and there is not enough medical evidence to support their safe use.

We only prescribe regulated HRT as recommended by the British Menopause Society. We do not prescribe compounded bioidentical hormones as these are not recommended, as there is no evidence that they are safe.

If testosterone gel is used, which is the most common application, excess body hair (particularly at the site of application), acne, and skin reactions to the gel happen in around 1 in 10 women.

Other side effects are rare with the dose of testosterone used for women but if they do occur, we would recommend that you stop and contact your doctor.

Yes, it is strongly recommended that you are adequately oestrogen replaced before starting testosterone.

It is essential to have a blood test before starting testosterone and during the treatment. This is to ensure that the testosterone levels in the blood are not too high as it can cause side effects.

It is essential to have a blood test after the first three months after starting testosterone replacement. In long-term management, it is necessary to have six monthly tests to monitor levels. Women on testosterone should have a full clinical review annually whilst on treatment.

Testosterone replacement can take up to 6 weeks to start showing the benefits. Maximum effects will be experienced within six months.

Testosterone comes in cream or gel format and is applied on the skin daily.