Exploring the Pros and Cons of HRT: A Pharmacist’s Guide

Written by Elizabeth Japal, Pharmacist and Co-founder of The Derma Lab, an Aesthetics Treatment Clinic.

Hot flushes, night sweats, fatigue, low mood — are these symptoms all too familiar for you? Unsure whether to try hormone replacement therapy (HRT)? 

Many women think HRT is a complicated subject, but it doesn't have to be. We believe passionately that women must be well-informed in order to make the best choices for themselves. In this article, we address some of the most common myths about HRT, as well as how it acts in the body, and the possible benefits and drawbacks. We hope you enjoy our handy Pharmacist’s Guide. 

Disclaimer:

The information provided in this article is for general informational purposes only and does not constitute medical advice. Always consult your doctor, pharmacist, or other qualified healthcare professional before making any decisions regarding hormone replacement therapy (HRT) or other health treatments. The content in this article should not be used as a substitute for professional medical advice, diagnosis, or treatment tailored to your individual health needs.

We will be covering:

• A breakdown of HRT: What it is, the types, and how it works.
• Benefits of HRT: Relief of menopausal symptoms, bone health, cardiovascular health, and quality of life improvements.
• Risks and drawbacks of HRT: Potential cancer risks, cardiovascular risks, common side effects, and long-term uncertainties.
• Pharmacist’s perspective: How pharmacists assess and personalise HRT, the importance of patient counselling, and collaboration with healthcare providers.
• Possible alternatives to HRT: Lifestyle changes, non-hormonal medications, and herbal remedies.

Definition

Hormone Replacement Therapy (HRT) involves supplementing the body with hormones, primarily oestrogen and progesterone, to alleviate symptoms associated with menopause. It is primarily used to treat hot flushes, night sweats, mood swings, and other menopausal symptoms.

Types of HRT

There are different types of HRT tailored to individual needs:

• Oestrogen-only HRT: Prescribed for women who have had their uterus (womb) removed during a hysterectomy. Oestrogen-only HRT products are available as tablets, patches, sprays or gels.
• Combined HRT: Contains both oestrogen and progesterone, suitable for women who still have their uterus. Taking both hormones reduces the risk of developing womb cancer. The hormones may be available as separate HRT products or combined within a single product.
• Bioidentical Hormones: Hormones that are chemically identical to those the human body produces. They can be compounded individually for patients but are often debated in terms of safety and efficacy.

Mechanism

HRT works by replenishing the levels of oestrogen and progesterone that naturally decline during menopause. This helps to stabilise hormone levels, reducing menopausal symptoms and helping maintain bodily functions that rely on these hormones. HRT routines can be cyclical or continuous with the delivery of the different hormones. This will be dependent on certain factors such as what stage of menopause you are at or the symptoms that you are experiencing.

Symptom Relief

One of the primary benefits of HRT is the significant relief from menopausal symptoms. It effectively reduces hot flushes, night sweats, and mood swings, improving overall comfort and quality of life during menopause.

Bone Health

HRT plays a crucial role in maintaining bone density. Oestrogen helps prevent bone density loss, reducing the risk of osteoporosis and fractures, which are more common post-menopause due to the decrease in oestrogen levels.

Cardiovascular Health

Some studies suggest that HRT may have cardiovascular benefits when started near the onset of menopause. Oestrogen has a protective effect on your heart and as levels begin to fall prior to and during menopause, fat can build up in your arteries and cholesterol levels can begin to rise. Oestrogen, which is found in HRT, helps to prevent the build up of fat within blood vessels and also helps to maintain the elasticity of blood vessels, potentially reducing the risk of heart disease by keeping your blood vessels healthy.

Quality of Life

Many women report an improved quality of life when using HRT. The alleviation of symptoms allows for better sleep, mood, and energy levels, enabling women to maintain their usual activities and overall well-being.

Cancer Risks

One of the most significant concerns with HRT is the potential increased risk of certain cancers:

• Breast Cancer: Some studies have indicated an elevated risk of breast cancer with long-term use of combined and oestrogen- only HRT. Combined HRT affects breast cancer risk more than oestrogen-only.  
• Ovarian Cancer: There is a small increased risk of ovarian cancer associated with all types of HRT, although the risk diminishes after discontinuation.
• Womb (endometrial) Cancer: Oestrogen-only HRT increases the risk of womb cancer. This is why it is usually only offered to women who have had a hysterectomy. 

It is worth noting that the risk of cancer for all types of HRT reduces once the HRT is stopped. 

Cardiovascular Risks

The relationship between HRT and cardiovascular health is complex:

• Heart Disease: While HRT may benefit heart health if started early, it can increase the risk of heart disease if begun many years after menopause.
• Stroke: HRT has been associated with a slightly increased risk of stroke, particularly in older women.

Other Side Effects

Common side effects of HRT include:

• Weight gain
• Bloating
• Breast tenderness
• Mood changes

Long-term Uncertainty

There is still uncertainty about the long-term effects of HRT, particularly concerning bioidentical hormones and compounded therapies. Ongoing research is needed to fully understand these risks and benefits.

Patient Assessment

Pharmacists play a crucial role in assessing whether a patient is a good candidate for HRT. This involves reviewing medical history, current health status, and individual symptoms to tailor the therapy appropriately.

Personalised Therapy

HRT is not one-size-fits-all. Pharmacists work to personalise therapy, ensuring the right type and dosage of HRT is used. Regular monitoring and adjustments are essential to address changing needs and minimise risks.

Counselling

Pharmacists are key in educating patients about HRT. They provide information on how to take the medication, potential side effects, and what to expect, ensuring patients are well-informed and comfortable with their treatment plan.

Collaboration with Healthcare Providers

Pharmacists collaborate closely with doctors and other healthcare providers to ensure comprehensive patient care. This team approach ensures that all aspects of a patient’s health are considered, providing the best outcomes for HRT therapy.

Lifestyle Changes

Non-hormonal strategies can also help manage menopausal symptoms:

• Diet: A balanced diet rich in calcium and vitamin D supports bone health. Phytoestrogen-rich foods like soy may help alleviate symptoms.
• Exercise: Regular physical activity helps manage weight, improve mood, and maintain bone density.
• Stress Management: Techniques such as yoga, meditation, and deep breathing can reduce stress and improve overall well-being.

Non-Hormonal Medications

Several non-hormonal medications can help with menopausal symptoms:

• Antidepressants: Certain SSRIs and SNRIs can reduce hot flushes and mood swings.
• Gabapentin: Typically used for nerve pain, gabapentin can also help reduce hot flushes.

Herbal Remedies and Supplements

Many women turn to herbal remedies and supplements, such as:

• Black Cohosh: Often used for hot flushes, though evidence on its efficacy is mixed.
• Red Clover: Contains phytoestrogens that may help with symptoms.
• Vitamin E: Some women find relief from hot flushes with vitamin E supplements.

It is important to consult with healthcare providers before starting any new supplements to ensure safety and avoid interactions with other medications.

In Summary

Hormone Replacement Therapy offers significant benefits in relieving menopausal symptoms, improving bone health, and potentially aiding cardiovascular health. However, it also carries risks, including potential cancer and cardiovascular concerns, as well as common side effects.

Making a Decision

Weighing the pros and cons of HRT is essential. It is important to consider individual health needs, preferences, and risks.

Consult with your healthcare providers, including your pharmacist, to make an informed decision about whether HRT is right for you. Pharmacists can provide valuable insights and personalised guidance to ensure the best possible outcomes.

Pharmacists expertise lie with medicines which means they are a great option for gaining advice regarding HRT and discussing what options are available either privately or via the NHS. Pharmacists are often more easily accessible than GPs so always consider having a chat with your local pharmacist first.

Pharmacists may be able to prescribe if working within a private HRT clinic or even within your NHS GP practice so again can be one of the healthcare professionals that help manage your menopausal symptoms. If you have been prescribed HRT by your GP, Pharmacists can also offer advice regarding side effects and how to get the best from your medication - most GP surgeries will have access to a Pharmacists or drop into your local Pharmacy.

Further Reading

For more information on HRT, consider these reputable sources:

• NHS website
• British Menopause Society
• Cancer Research UK
• British Heart Foundation

Time to take control

Put on your big girl boots. Our hormones know what is best for us — and our winning formula takes the prize! 

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