What about side-effects when taking HRT?

For short-term treatment of menopausal symptoms

If
you are troubled with menopausal symptoms, the balance of risks and
benefits is probably in favour of taking HRT (provided there are no
reasons why you shouldn't take HRT). You may be happy to accept the
small risk of taking HRT for 1-3 years to be free of symptoms. You
should take the lowest dose which keeps symptoms away. Many women find
that after 1-3 years the worst of the flushing-type symptoms have gone
and they no longer need HRT to prevent them. In some women, the
symptoms can return for a short time after stopping HRT. If the genital
symptoms such as vaginal dryness persist after stopping HRT, an option
is to use an oestrogen cream or pessary in the vaginal area (see
below).

So, if women start HRT around the time of the
menopause to help symptoms, the risks are small. However, these risks
increase with age. Therefore, it is not usually appropriate for older
women to start HRT, as the risks are increased.

For healthy women without symptoms and a menopause at around 50 or over

If
you have little in the way of symptoms, HRT is usually not advised as
there is little to be gained, and even the small risks of HRT are then
unacceptable.

If you mainly have genital symptoms such as a dry vagina

An
option which may be advised by your doctor is to use a vaginal
oestrogen cream or pessary. This gives the benefits of easing the
symptoms, but with less risk than using HRT tablets, patches, etc, as
less oestrogen gets into the bloodstream. In some women, this treatment
may be needed long-term. Your doctor may suggest that you stop the
treatment from time to time to see if you still need it.

What about taking HRT to help prevent osteoporosis?

A
few years ago HRT was widely used to prevent osteoporosis. However,
recent research has shown that there are potential serious health risks
with taking HRT (described above). So, we now know that the balance of
risks and benefits for most women is usually not in favour of taking
HRT just to prevent osteoporosis.

However, if you have an early
menopause, HRT may be advised until you are aged 50. This is to help to
prevent osteoporosis (and ease menopausal symptoms if they occur). You
have an increased risk of developing osteoporosis if you have an early
menopause. Some of the health risks of taking HRT are thought to be
smaller until you reach the usual age of menopause (about aged 50).

Stopping hormone replacement therapy

Your
doctor will usually follow you up regularly if you are taking HRT. They
may suggest a short period off HRT from time to time to see if you
still need it. For example, if you have been taking HRT for one to two
years and you have no symptoms, your doctor may suggest a trial of
stopping your HRT.

Some women do not notice any symptoms if they
stop HRT abruptly, while others may experience a recurrence of symptoms
such as hot flushes and sweats. These usually go after a few months.
Some experts suggest that HRT should be gradually reduced rather than
stopped abruptly.

Once your HRT has finished you may need some treatment for vaginal dryness (such as a cream or a lubricant).

You
may also need some treatment to prevent osteoporosis such as
bisphosphonates, calcium and vitamin D supplements. (See separate
leaflet called 'Osteoporosis' for details.)