If you do not want to get pregnant, you should use contraception until 2 years after your last period if you're under 50 or for 1 year after the age of Most women stop taking it when their menopausal symptoms pass.
This is usually after a few years. Gradually decreasing your HRT dose is usually recommended. This is less likely to cause your symptoms to come back. Talk to your GP if you have severe side effects or your side effects continue for longer than 3 months. Page last reviewed: 7 July Next review due: 7 July Read our cookies policy to find out more about our cookies and how we use them. There are different types of HRT.
Your GP will help you choose the best type for you. HRT medicine comes as tablets, skin patches, gels, and vaginal creams, pessaries or rings. It helps relieve most of the menopausal symptoms, such as: hot flushes night sweats mood swings vaginal dryness reduced sex drive Many of these symptoms pass in a few years, but they can be unpleasant. You may fear that you have missed your window not only to derive the greatest benefits of HRT, but to receive treatment at all. Many women continue to experience a plethora of disruptive symptoms in their postmenopausal years , compromising overall health, functionality, and quality of life.
Meanwhile, you are facing an ever-increasing risk of bone density loss and osteoporosis. But, now, that is changing. It is true that many of the protective benefits of HRT appear to diminish or disappear with age. It is also true that older women may be more likely to have risk factors that make them less than ideal candidates for HRT. However, for many women, HRT can be a truly transformative, positive intervention even after the age of Growing understanding of the benefits of hormone therapy for older women recently led the North American Menopause Society to update its position on HRT after According to their position statement :.
Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 years for persistent [vasomotor], [quality of life] issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.
With this new understanding, more women can realize the benefits of HRT and preserve their quality of life as they age. However, research suggests that older women should try to stick to particular types of hormones and administration methods to reduce health risks.
While most women experience natural menopause around the age of 50, some women reach menopause much earlier or after surgery. In these cases, HRT should typically be started immediately. Menopause that happens before the age of 40 is known as premature menopause, while between 40 and 45 it is known as early menopause. Women who experience premature or early menopause can have the same symptoms as women who experience typical menopause, but may also be at greater risk for psychological distress and a number of serious physiological health conditions.
Meanwhile, women who undergo oophorectomy—surgical removal of one or both ovaries—prior to natural menopause can experience even more severe symptoms due to the extreme and sudden drop in hormones as well as significant long-term health risks. For all women who experience premature, early, or surgical menopause these risks include cardiovascular disease, osteoporosis, neurological disease, mood disorders, and premature death. Due to these risks, it is typically recommended that women who experience premature, early, and surgical menopause start hormone replacement therapy as soon as possible.
As the American Society For Reproductive Medicine, mincing no words, said of bilateral oophorectomy patients:. For women who experience premature or early menopause, HRT is strongly recommended until the average age of menopause around 51 years , unless there is a particular reason for a woman not to take it.
Other therapies, including vaginal oestrogen products, antidepressants or other medications, may be used depending on the symptoms and risk factors. Seek advice from your doctor. HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:. HRT needs to be prescribed for each woman individually. Some women experience side effects during the early stages of treatment, depending on the type and dose of HRT.
These side effects will usually settle within the first few months of treatment and may include:. These small risks must be balanced against the benefits of HRT for the individual woman. Talk to your doctor about any concerns you may have. Women over 50 years of age who use combined oestrogen and progestogen progesterone replacement for less than five years have little or no increased risk of breast cancer.
Women who use combined HRT for more than five years have a slightly increased risk. Women on oestrogen alone have no increased risk up to 15 years of usage. There is no evidence to suggest that a woman with a family history of breast cancer will have an added increased risk of developing breast cancer if she uses HRT. The risk with combined oestrogen and progestogen is greater than with oestrogen alone, or with newer HRT agents such as tibolone sold as Livial or Xyvion , and may also depend on the type of progestogen used.
Studies suggest that medroxyprogesterone acetate and norethisterone have higher risks than dydrogesterone and progesterone. Women over 60 have a small increased risk of developing heart disease or stroke on combined oral tablet HRT. Although the increase in risk is small, it needs to be considered when starting HRT, as the risk occurs early in treatment and persists with time. Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch.
Similarly, tibolone increases the risk of stroke in women from their mids. Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more. Venous thromboses are blood clots that form inside veins. Women under 50 years of age, and women aged 50 to 60, face an increased risk of venous thrombosis if they take oral HRT.
The increase in risk seems to be highest in the first year or two of therapy and in women who already have a high risk of blood clots. This especially applies to women who have a genetic predisposition to developing thrombosis, who would normally not be advised to use HRT. Limited research to date suggests the increased risk of clots is mainly related to combined oestrogen and progestogen in oral tablet form, and also depends on the type of progestogen used.
Some studies suggest a lower risk with non-oral therapy patches, implants or gels or tibolone. The endometrium is the lining of the uterus. Use of oestrogen-only HRT increases the risk of endometrial cancer, but this risk is not seen with combined continuous oestrogen and progestogen treatment. There is no risk if a woman has had her uterus removed hysterectomy. The increased risk of ovarian cancer is very small and estimated to be one extra case per 10, HRT users per year.
A recent review linked HRT to two types of tumours: serous and endometrioid cancers. Cholecystitis is a disease in which gallstones in the gallbladder block ducts, causing infection and inflammation. On average, there is a slightly higher risk that a woman will develop cholecystitis when using oral HRT, but patch treatment is associated with a lower risk. Treatment for cholecystitis includes surgery to remove the gallbladder.
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