The most successful treatment for menopausal symptoms is with Hormone Replacement Therapy (HRT). Oestrogen is given at a high enough level to stop menopausal symptoms. If you have a uterus (womb) the oestrogen can cause the lining of the uterus to thicken, so to prevent this another hormone called progestogen is given in addition – this is called combined HRT. If you do not have a uterus (e.g. you have had a total hysterectomy which removes the uterus and the cervix (neck of the womb) too) then you do not require progestogen and can be treated with oestrogen alone.
Using oestrogen transdermally (through the skin), in the form of a gel or a patch, is the safest way of taking oestrogen and there are very few women for whom HRT in this way would not be suitable. It can also be used directly in the vagina to treat vaginal dryness using a vaginal tablet (pessary), vaginal ring or a cream. Oestrogen can also be given in an oral tablet, but it comes with additional risks which transdermal oestrogen does not have.
If it is required, the progestogen can be given either transdermally (in a patch), orally, vaginally (in a tablet) or in the form of a Mirena® coil.
If you are still having periods or it has been less than a year since your last period, then HRT is given in a “cyclical” or “sequential” way which means you have oestrogen every day and progestogen for 12-14 days a month. This will cause a regular bleed.
If it has been more than a year since your last period then you will usually be given “continuous combined HRT” which is when you have oestrogen and progestogen every day. This should lead to no bleeding, although it is quite common to have some bleeding in the first 3-6 months of starting continuous combined HRT.
There is another available synthetic hormone called Tibolone which can be used in women whose last period was over a year previously. It acts like a combination of oestrogen, progestogen and testosterone.
In most women, oestrogen (and progestogen if required) is enough to treat menopausal symptoms. In women who continue to have low libido, testosterone can sometimes be helpful. Testosterone is usually prescribed only once we are sure that you are on an optimum amount of oestrogen. It is given in the form of a gel or cream.