Menopause & HRT Treatments

Menopause is a natural biological process that occurs when a woman’s ovaries stop producing oocytes (early eggs) and menstruation ceases. This usually happens between the ages of 45 and 55 but can vary among individuals. During menopause, the body experiences hormonal changes, with reduced production of oestrogen and progesterone, often resulting in uncomfortable symptoms.

Hormone replacement therapy (HRT) is a category of treatment that is used to replace or supplement hormones in the body. It is commonly used to treat post-menopausal symptoms that occur due to a natural decrease in hormone levels that happens at that phase of life.

The two primary hormones that are used in menopause HRT are oestrogen and progesterone, which can be administered in various forms like pills (both oral and vaginal), patches, creams, gels, injections and implants. The choice of the hormone, administration method, dosage, and duration of treatment depends on individual factors, medical history, and personal preferences.

During your life, your body's hormonal levels undergo natural fluctuations. While some women transition into menopause with minimal or no symptoms, these changes are normal and can lead to a range of postmenopausal symptoms. If you find your daily life significantly impacted by postmenopausal symptoms, it might be worth considering the initiation of HRT treatments.

Some of the indicators that hormone replacement therapy might be necessary are:

• mood changes
• irritability
• sleep problems
• hair loss
• urinary problems
• discomfort, irritation, or a burning sensation during sexual intercourse
• low sex-drive
• vaginal dryness and atrophy
• night sweats
• hot flushes
• bone density loss

There are two main types of oestrogen-based treatments that can be used to address the symptoms of menopause:

• Systemic hormone (oestrogen) replacement therapy - refers to the process of replacing the body’s levels of oestrogen at the time of menopause with oestrogen that comes in pill, skin patch, ring, gel, cream or spray form. These treatments can be used to treat any of the common symptoms of menopause as they contain a higher dose of oestrogen that is absorbed throughout the body.
• Vaginal products containing a low dose of oestrogen - these products come in cream, tablet or ring form and can be used to minimise the amount of oestrogen absorbed by the body. Because of this, low-dose vaginal preparations are usually only used to treat the vaginal and urinary symptoms of menopause.

The timeline for experiencing the benefits of hormone replacement therapy (HRT) can vary. While some individuals might start sensing changes in a matter of days or weeks, the complete outcomes of HRT usually require more time to manifest. Generally, it may take a few weeks to notice the effects of HRT, with the full impact becoming evident over a span of up to 3 months.

Vaginal HRT typically takes a bit longer to exhibit its effects and the severity of symptoms can also influence the duration needed for the treatment to take effect. Although improvements might be noticeable within the initial three months, it can take up to a year to experience the full impact due to structural changes occurring in the vaginal and genital area during menopause.

Perimenopause is the transitional phase leading up to menopause, when oestrogen levels start to fluctuate and periods often become irregular. It can last several years and is when most of the classic symptoms, such as hot flushes, mood changes and sleep disturbance, first appear. Menopause itself is a single point in time, defined as 12 consecutive months without a period. Once you have reached that point, you are considered postmenopausal, which is when many women turn to vaginal HRT treatments like Gina for ongoing symptoms such as dryness and discomfort.

Menopause itself is a single moment, the point 12 months after your last period, but the surrounding transition can last considerably longer. Perimenopause commonly lasts around four to eight years, and postmenopausal symptoms such as hot flushes, joint pain and sleep disturbance can continue for several years afterwards for some women. Everyone's experience differs, and how long symptoms persist depends on individual hormone levels, lifestyle and whether any treatment is used to manage them.

No, most cases of bleeding after menopause are not cancer. The most common causes are thinning of the vaginal or womb lining (atrophy) due to lower oestrogen levels, or polyps, both of which are benign. However, because a small proportion of cases are linked to womb cancer, any bleeding that occurs 12 months or more after your last period should always be checked by a GP promptly, even if it is very light spotting or happens only once. Early investigation means any underlying cause can be identified and treated quickly.

Hot flushes happen because falling oestrogen levels affect the part of the brain that regulates body temperature, making it more sensitive to small changes and triggering a sudden feeling of heat, flushing and sweating. They are one of the most common menopause symptoms and can also be triggered or worsened by caffeine, alcohol, spicy food, stress and warm environments. If hot flushes are significantly affecting your daily life, a consultation can help determine whether HRT or another treatment option may be suitable for you.

Yes, disrupted sleep is one of the most commonly reported menopause symptoms, often caused by night sweats, but also linked to hormonal changes affecting sleep quality directly. Keeping your bedroom cool, limiting caffeine and alcohol in the evening, and sticking to a consistent sleep schedule can all help. Vitabiotics Menopace Night is specifically formulated to help minimise the risk of sleep disturbances during and after menopause, and may be worth considering if broken sleep is a persistent issue for you.

The Suresign Menopause Rapid Test detects follicle stimulating hormone (FSH) in urine, a hormone that rises as the ovaries become less responsive during the approach to menopause, and can return results with over 99% accuracy in just three minutes. The kit includes two tests, usually taken about a week apart, since FSH levels can fluctuate. It is worth noting that a positive result most often indicates perimenopause rather than a definitive menopause diagnosis, and contraception should not be stopped on the basis of a test result alone. If symptoms persist regardless of the result, speak to a GP.

Gina vaginal tablets contain a 10-microgram micro-dose of estradiol, one of the lowest available doses of vaginal oestrogen, designed to relieve postmenopausal vaginal dryness, soreness and discomfort with minimal absorption into the rest of the body. They are suitable for women aged 50 and over who have not had a period for at least a year, and symptoms typically start to improve within four to eight weeks of starting treatment.