How are the symptoms of menopause treated?
Hormone replacement therapy (HRT) aims to restore estrogen to premenopausal levels in order to reduce symptoms and also to protect against the long-term effects of reduced estrogen levels. Estrogen protects women against cardiovascular disease and osteoporosis while the risk of developing these diseases increases as levels of the hormone fall. Lack of estrogen is an additional risk factor for cardiovascular disease but not a sole cause. Other risk factors include smoking, high blood pressure, obesity and high cholesterol. Similarly, there are other factors besides menopause that affect a woman’s likelihood of developing osteoporosis, such as being very underweight (particularly women who may have suffered from anorexia nervosa), lack of exercise in youth, and lack of calcium (particularly as a child).

The results of recent studies have shown that HRT does not have any beneficial effects on cardiovascular disease but that it does offer women protection against osteoporosis and fractures in the long term. However, after consideration of the risks and benefits, HRT is recommended for use in the prevention of osteoporosis only in postmenopausal women at high risk for future fractures who are intolerant of, or contraindicated for, other medicines approved for osteoporosis prevention. While studies have shown that women using HRT for longer than five years have a slightly increased risk for breast cancer compared with non-users, this risk must be weighed up against the consequences of not using HRT. Your doctor will explain the risks and benefits of HRT in more detail if you are concerned.

How is the treatment given?
HRT may be given in various forms and dosages. A combination of estrogen and progesterone is usually given, except in women who have had a hysterectomy who do not require the progesterone component. HRT preparations contain a similar combination of hormones to those in the contraceptive pill but in much lower dosages. HRT is available as tablets, skin patches, creams, gels, intravaginal rings, suppositories and implants. HRT should be used at the lowest effective dose for the shortest possible time. Some women may be unable to use HRT, for example, those with a history of blood clots or breast cancer.

Estrogen can be given in the form of a cream, gel, suppository or vaginal ring to women who are suffering from vaginal dryness and subsequent discomfort during intercourse. It may be useful if no other menopausal symptoms are present, or as an addition to HRT treatment. The hormone given is estradiol (Estrace, Climara), or conjugated estrogens (Premarin).