Hormone replacement therapy (HRT) is usually the first-line treatment to improve symptoms of perimenopause and menopause [1]. It works by topping up or replacing your missing hormones. HRT is also used for women who have hormonal changes, including those with premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postnatal depression and sometimes for women with polycystic ovary syndrome (PCOS) and endometriosis.
Types of HRT usually contain estradiol (the beneficial type of estrogen), progesterone and testosterone.
What is HRT made from?
In the past, estrogen was only given as a tablet that was derived from pregnant horses’ urine or as a synthetic form called ethinylestradiol. The majority of estrogen now prescribed is estradiol. Now, all three hormones that are commonly prescribed in HRT - progesterone, estradiol and testosterone - have the same molecular structure as our own hormones so are not associated with the risks of older, synthetic hormones. When hormones have the same molecular shape as the hormones your body naturally produces, they are called body identical hormones.
RELATED: Body identical hormones
What is estradiol and what do I need it for?
Estradiol is a hormone produced by our ovaries, adrenal glands, brain and other tissues. It helps to regulate our menstrual cycles and the development of female characteristics during pregnancy, such as breasts. It works on every cell in our bodies, plays important roles in bone health, memory and cognition and cardiovascular health and is essential for many bodily functions. When levels of estradiol fluctuate and fall, this can trigger wide-ranging and varying symptoms, including low mood, anxiety, memory problems, poor sleep, joint aches and pains, brain fog, hot flushes and vaginal dryness.
How is estradiol given in HRT?
Estrogen can be given either through your skin, known as transdermal oestradiol, as a patch, gel or spray or orally in the form of a tablet. Transdermal estradiol is absorbed directly through our skin into our bloodstream. This means that it bypasses our liver and causes less side effects. There is no risk of clot or stroke with transdermal estradiol. Another benefit of transdermal estradiol is that doses can be altered more easily, allowing you to be treated individually and have your dose and type tailored to your symptoms and health.
RELATED: Estrogen in patches, gels or sprays
What is progesterone and what do I need it for?
Progesterone is a hormone produced in your ovaries, brain and other tissues. It plays an important role in your menstrual cycle, supports pregnancy and works throughout your body to reduce inflammation. Progesterone is commonly thought of as the “relaxing hormone” as, for most women, it has calming, anti-anxiety (anxiolytic) properties. One function of progesterone HRT is to keep the lining of your womb thin and to ensure unexpected bleeding does not occur when you are taking estradiol. Progesterone is also prescribed to relieve symptoms such as sleeping problems, low mood and anxiety.
How is progesterone given in HRT?
There are two main types of progesterone: progesterone (the body identical form) and progestogen (the synthetic form). Progesterone can be given as an oral capsule, vaginal pessary, rectal pessary or cream. Progestogens are synthetic forms of progesterone (with different molecular structures) used in contraception and symptoms of intolerance are much more common with progestogens.
There are more risks associated with progestogens than with natural progesterone. Synthetic progestogens have been found to have a small risk of blood clot, heart disease and breast cancer [2]; although it is worth noting that these risks are very small, and your actual risk of such diseases depends much more on your overall health, genetics, weight, and lifestyle habits.
RELATED: Utrogestan (micronised progesterone) explained
What is testosterone and what do I need it for?
Testosterone is an important hormone that's produced by our ovaries, adrenal glands and brain, as well as made in other organs and tissues. Testosterone is perhaps best known for influencing libido but it has a significant impact beyond this – we have testosterone receptors in cells all over our bodies. Testosterone contributes to mental sharpness and clarity, helps to protect against memory loss and helps improve mood. It also helps with muscle mass and bone strength, cardiovascular health, and overall energy levels and quality of sleep.
How is testosterone given in HRT?
Testosterone is usually prescribed as a cream or gel, and you usually rub it into skin of your thighs or bottom. There are usually no side effects with testosterone treatment as it is given to replace the testosterone that you are otherwise lacking.
RELATED: The importance of testosterone for women
