HRT and the menopause

Hormone Replacement Therapy (HRT) and the menopause

During the menopause, there is a sharp decrease in the amount of oestrogen (known as oestrogen depletion) and progesterone produced by the ovaries. 

As well as causing irregular periods during the menopausal transition, oestrogen depletion causes the characteristic symptoms of menopause, such as hot flushes and night sweats, which are known as ‘vasomotor symptoms’. It can also cause mood changes and other menopausal symptoms. 

Hot flushes and night sweats 

Hot flushes can make you suddenly feel warm or hot without any apparent reason. This can result in a red skin flush and a rapid heartbeat before you then suddenly feel cold. Hot flushes that happen when you are sleeping are called night sweats. These nights sweats can be intense and may cause you to wake from your sleep. The intensity and frequency of hot flushes and night sweats will vary across women. They may last from one minute to five minutes and range from mild to severe. Some women may experience multiple hot flushes in an hour or only once a week. 

Sleep issues 

You may experience trouble sleeping or find you are waking up during the night. This can happen for many reasons. This may be an indication that you are approaching menopause – particularly if you don’t normally experience sleep issues. Other menopausal symptoms (like night sweats) can also cause these sleep issues. If sleep problems persist, and you can’t pinpoint why, you should speak to your doctor. 

Mood swings 

Many women experience mood changes during menopause and can feel anxious or down. You may not recognise these changes as menopause symptoms. If you do experience mood changes and they are concerning you, you should talk to your doctor about them.

Difficulties in concentration 

Forgetfulness can also be a symptom associated with the menopause. Both men and women can experience memory lapses as they enter middle age such as forgetting a word or misplacing an item. This can be linked to not only menopause but stress and other causes. If this is an issue you have noticed, talk to your doctor about it. 

Changes in physical appearance 

Menopause can cause many physical changes such as hair and skin becoming drier and thinner. Weight gain has also been reported by some women as well as other body changes such as more fat and less muscle around the body in general. Stiff joints or joints that hurt can also be linked to physical changes caused by menopause. You may find it a little harder to move so it is important to stay active and exercise in order to keep your strength and stay in shape. 

Feeling differently about sex 

The menopause can affect women differently in regards to sexual libido. Some women report having less of an interest in sex or arousal difficulties. Other women report enjoying sex more and feeling freer due to a lack of worry of pregnancy. If you are concerned about the changes you are experiencing, talk to your doctor about what can be done to help.

Vaginal Atrophy 

Reduction in oestrogen can cause vaginal dryness, pain/burning sensation, or severe itching. These symptoms can lead to discomfort during sex, urgency with urination and recurrent urinary tract infections. Vaginal atrophy is the name given to the deterioration of vaginal tissues due to loss of oestrogen. This occurs in over 50% of postmenopausal women. Many women will use vaginal moisturisers and lubricants, and these can be effective, but lubricants do not have long-lasting effects and mainly provide short-term relief during intercourse. There are local vaginal treatments available from your doctor which replaces the oestrogen your vagina needs to stay healthy. Don’t be embarrassed and talk to your doctor today about treatment options. 

There are many symptoms of the menopause which impact both physical and mental health. Click the button below to learn more about the language of the menopause from those who are living with it.

How does HRT work? 

For women who seek help for their menopausal symptoms, HRT is the most commonly prescribed treatment. HRT works by replacing the depleted oestrogen in your body, so that you have a similar level as you had before the menopause. 
If you still have your womb you should be prescribed progesterone as well. This is because the oestrogen you are replacing causes the lining of your womb to grow as it did when you had your periods. Taking progesterone as well as oestrogen causes the lining of the womb to shed, preventing problems caused by the build-up of the womb lining. As a result, depending on the progesterone taken, you may experience some bleeding at the end of each treatment cycle, similar to a menstrual period.  

Keeping a healthy lifestyle can help to minimise the effects of the menopause 

A healthy diet

The fall in the level of oestrogen that is part of the menopause can increase the risk of heart disease and osteoporosis. Keeping your diet low in saturated fat and salt can reduce blood pressure, and food rich in calcium and vitamin D helps to strengthen bones. 

Regular exercise

Mood changes and anxiety often arise as a result of the menopause. Taking regular exercise helps to improve mood and is also important for the health of your heart and bones. 

Stop smoking

Smoking has been shown to lead to an earlier menopause and to trigger hot flushes. Smoking also increases the risk of osteoporosis and coronary heart disease, which is one of the most common causes of death in women. 

Drink within reason

Alcohol increases hot flushes and increases the risk of breast cancer. Try not to drink more than 2 units of alcohol ‘a day’ and no more than 14 units a week, and keep at least one day a week alcohol-free.

Keep positive

Relaxation techniques and counselling can be very helpful in coping with anxiety and low mood that can arise as a result of the menopause. 

Reporting Side Effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at: or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.