This guide is not individual advice but aims to provide a basic understanding of the types of Hormone Replacement Therapy (HRT) and their appropriateness depending on whether you are in perimenopause or menopause.
Key Principles of HRT
1️⃣ Micronized Progesterone and Topical Oestrogen: These are preferred due to their safety profiles. However, younger women without risk factors for deep vein thrombosis (DVTs) such as obesity, smoking, or a history of DVTs can still safely use oral oestrogen. Women with an intact uterus (i.e., those who have not had a hysterectomy) will need a form of progesterone to protect the endometrium from hyperplasia.
2️⃣ Perimenopause: If a woman is in perimenopause and still having periods, the oral contraceptive pill with 17-beta oestradiol can be a good option as it suppresses ovulation and hormonal fluctuations, effectively managing symptoms. Other options include cyclical progesterone (two weeks per month) or a Mirena IUD combined with continuous oestrogen (topical preferred).
3️⃣ Post-Menopause: After menopause, continuous progesterone is recommended, generally with micronized oral progesterone or through a combined patch.
4️⃣ Tibolone: This is another option after menopause. Tibolone is a prodrug derived from a Mexican yam that is metabolized into oestrogen, progesterone, and testosterone. It does not require additional progesterone and can help with low libido. Randomized controlled trials (RCTs) have shown that Tibolone reduces fractures, breast cancer, and colon cancer. However, it should not be used in women over 60 due to a small increase in stroke risk and is not recommended for those with a history of breast cancer.
5️⃣ Vaginal Oestrogen: This can be beneficial for treating vaginal dryness and bladder symptoms but will not address hot flashes.
Empowering Women with Knowledge
These guidelines are not suggesting that every woman should go on HRT at menopause. Instead, they aim to empower women with knowledge about HRT as the most effective treatment for menopause symptoms, which is generally very safe and offers health benefits that likely outweigh the risks for many women. If you are experiencing a difficult menopause, consider consulting your GP or a doctor registered with the Australian Menopause Society. 💛