The Truths about HRT

So can we go back to basics, Olivia and Heather? I think just to recap on, you know, what is systemic HRT, the localized, you know, vaginal estrogen, the differences with that.

Just we can refer people back to previous episodes, but I think it's good to just go back to what actually is HRT and, um, why is all this complexity surrounding it.

I mean, I think it's really good to be asking this question because I see quite a lot of women in clinic who now have been put on HRT and still aren't really sure what they're on and why they're on it.

Um, so the basics of what we call systemic HRT, so these are the hormones that go into your whole system, are estrogen of some kind, and we can either give that via the skin, um, and that is as a gel, a patch, or a spray, or we can give that by mouth as a tablet, and that's usually in the form of estradiol.

So that is the mainstay of HRT, and that is what is hopefully going to treat the symptoms.

We also know that if you take estrogen without protecting your womb lining, then your womb lining can grow as a result of that estrogen.

So if you are someone with a womb, you need to take something to protect the womb lining, and that is a progestogen.

And that again can come in many forms.

So sometimes that can be combined with the estradiol, either in a tablet or a patch, or sometimes you can take that separately as a tablet.

Um, so a lot of really popular way of taking the progestogen is as the Mirena coil, which is a little plastic thing which you insert into the womb.

So that is the mainstay of what we call systemic HRT.

I think it might also be worth reminding people what are the reasons to take HRT.

Um, there's a lot more confidence in use of HRT now than there has been, um, in the last recent years.

More than 20 years ago, there was huge confidence in HRT, then it dropped, and now it's come back again.

And sometimes I think we lose the focus a bit.

As you mentioned, Olivia, you said some people don't quite know what they're taking or why they're taking it.

And there are th- three indications for taking what Olivia's just described perfectly, which is systemic HRT.

The main one is for control of symptoms which are due to becoming low in estrogen during that menopause transition and post-menopause.

That will continue to be the main reason for taking HRT, so it's understanding what are the symptoms and what impact they're having.

And then the second reason, if someone has an early menopause under the age of 45 or menopause under the age of 40, that you're still treating symptoms often then, but also you want to protect bone health and heart health, which is increased in women who stop having their estrogen at a younger age than normal.

And the third reason is if someone has h- risk factors or has been shown to have osteoporosis, especially if they're under 60 and if they're also having symptoms.

So just I think it's important to remember why people take HRT.

And you can't generalize about giving HRT.

I think this is where the, some of the confusion comes in for, um, for patients, is that, you know, they'll think, "Well, okay, so and so is having that patch.

I'll just have that because that's working well for her." But it, it massively de- depends, you're taking that individualized approach.