There are different types of HRT, treatment plans and ways of taking HRT. Your GP will help find the right treatment for you.
HRT hormones
HRT balances and replaces the hormones that your body no longer produces in the same way because of perimenopause and menopause.
Oestrogen and progestogen
The 2 main hormones used in HRT are oestrogen and progestogen.
Types of oestrogen include estradiol, estrone and estriol.
Types of progestogen include dydrogesterone, medroxyprogesterone, norethisterone, micronised progesterone and levonorgestrel.
Most women take a combination of oestrogen and progestogen. But women who do not have a womb can usually take oestrogen on its own.
Women who have a womb must take both oestrogen and progestogen. This is to reduce your risk of womb cancer.
HRT treatment plans
The 2 types of HRT treatment plans are:
- cyclical (or sequential) HRT
- continuous HRT
The plan you use depends on the stage of menopause you are in.
Cyclical HRT
Cyclical HRT is also known as sequential HRT.
It is often recommended for women taking combined HRT who have menopause symptoms but still have their periods.
You take oestrogen every day, and take progestogen for the last 10 to 14 days of your menstrual cycle every month. Sometimes you may be asked to use the progestogen for more than 14 days per month.
Continuous combined HRT
Continuous HRT involves taking oestrogen and progestogen every day without a break.
Oestrogen-only HRT is also usually taken continuously.
Continuous combined HRT is usually for women who are postmenopausal. This is when you have not had a period for a year.
How and when to take HRT
HRT is available in different ways. Talk to your GP about the best option for you.
Your GP might prescribe your oestrogen as a gel, patch or spray if you:
- are at a higher risk of blood clots
- have a high body mass index (BMI)
- have diabetes
- have liver problems
- had side effects from using HRT tablets
Taking your oestrogen dose with food may help to reduce side effects, such as sickness and indigestion.
Tablets
Oestrogen-only and combined oestrogen and progestogen HRT tablets are available. They're usually taken once a day.
The risks of HRT, such as blood clots, is higher with tablets than with other forms of HRT.
Skin patches
You stick skin patches on your skin and replace them every few days. Oestrogen-only and combined oestrogen and progestogen HRT patches are available.
Using patches can help avoid some side effects of HRT, such as indigestion. HRT patches do not increase your risk of blood clots when you take the dose your GP has prescribed.
Oestrogen gel
Oestrogen gel is applied to the skin once a day and absorbed.
Taking oestrogen gel also avoids the increased risk of blood clots that comes with HRT tablets.
If you still have your womb, you will need to take progestogen also. You can take progestogen as part of combined HRT.
Another option is the intrauterine system (IUS). An IUS releases a progestogen hormone into the womb. It can stay in place for 5 years and also acts as a contraceptive.
Spray
A transdermal spray is an oestrogen spray you put on your skin.
You will usually start with 2 to 3 sprays every day, spraying it onto the skin on your inner forearm. Your GP will tell you how to use it.
If you still have your womb, you will also need to take progestogen or get an IUS put into your womb.
Vaginal oestrogen
Oestrogen is also available in the form of a cream, pessary or gel that is placed inside your vagina.
This can help relieve vaginal dryness, but it will not help with other symptoms such as hot flushes.
It does not carry the usual risks of HRT. You can use vaginal oestrogen without taking progestogen even if you still have a womb.
Testosterone
Testosterone is available as a gel that you rub in your skin.
It is usually only recommended for women whose low sex drive (libido) does not improve after using HRT.
It is used alongside your current HRT type.
Your GP can give you more information on testosterone products.
Content supplied by the NHS and adapted for Ireland by the HSE
