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As women pass their 40s and start imagining themselves on the bright side, a place where their uterus is not planning to (almost) kill them every month, they realize that the path is not very easy. Midlife crisis ensures to make its presence felt in the form of perimenopause and menopause. But whoever said menopause was all hot flashes and night sweats definitely didn't know what they were talking about!

What Is Menopause (In Real)?

Menopause usually hits a woman between the ages of 45 and 55. It is the time when the baby-making machine decides to shut down by stopping the process of ovulation. This means no more shark weeks!

However, menopause symptoms can last for several years (aka perimenopause) before periods stop completely. The estrogen (along with progesterone and testosterone) levels in the body start going downhill, resulting in mood swings, irregular bleeding, hot flashes, sleep issues, irritability, weight gain, and vaginal dryness. This in turn affects their mental health as women tend to feel disconnected, asocial, and cheerless.

"There are 13 million people affected by menopause in the UK, with 90 per cent of them having menopausal symptoms at some point," according to Meg Mathews, author of 'The New Hot: Taking on the Menopause with Attitude and Style’.

What is HRT?

Hormone Replacement Therapy (HRT), aka menopausal hormone therapy, is often used to treat the symptoms associated with menopause by changing the levels of hormones – specifically estrogen, progesterone, and testosterone - in the body. Depending on a woman’s specific symptoms, a doctor may prescribe either estrogen therapy or combination therapy, which involves the use of progestin, progesterone, and estrogen.

Sometimes, HRT is also used in the process of gender transition as per one’s desire.

How Does HRT Help in The Treatment of Menopause?

Hormone therapy or HRT replaces the depleting female hormones that the body is no longer producing. The process involves synthetically administering the depleting hormones into a woman’s body.

HRT can be prescribed as systemic (oral drugs, transdermal patches and gels, implants) or local therapy (creams, pessaries, rings).

Clinical menopausal symptoms like osteoporosis, vasomotor issues (leading to hot flashes and palpitations) and urogenital issues (vaginal dryness, soreness, urinary urgency) are known to be alleviated using HRT.

There have been some controversies surrounding the potential contraindications and risks of HRT, especially in older menopausal women. However, most experts agree that hormone replacement therapy is safe for otherwise healthy menopausal women. A doctor may be the best person to consult in case of any doubts regarding the same.

Types of HRT

Let’s talk about the three main types of hormone replacement therapy –

1. Estrogen Only HRT

Only estrogen therapy is used for women who have had a hysterectomy as they cannot develop uterine cancer. Estrogen is the hormone that provides relief from menopausal symptoms.

The preferred estrogen form is estradiol which is available in the form of oral pills, for example, Elleste Solo containing 1 mg estradiol (as estradiol hemihydrate). Other forms of estradiol may come as patches, rings, and vaginal tablets.

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2. Combined HRT

This involves the use of estrogen, progesterone, and progestin hormones. It’s meant for women who still have their uterus as estrogen, if given alone, may cause the lining of the uterus to overgrow, potentially leading to uterine cancer. Therefore, combining it with progestin (a progesterone-like hormone) prevents this risk.

Both oral and intrauterine progestins are available for treating the symptoms of menopause. Micronized natural progesterone is the preferred choice of HCPs today as it has several advantages over synthetic ones.

3. Cyclical HRT

Sometimes women experience menopausal symptoms but may still get their periods. Cyclical HRT, also known as sequential HRT, is often recommended for such a circumstance.

There are two types of cyclical HRT:

(i) Monthly HRT – This involves taking estrogen every day, while progesterone is taken alongside it for the last 14 days of the menstrual cycle. It is usually recommended for women with regular periods.

(ii) 3-monthly HRT – This involves taking estrogen every day, while progesterone is taken alongside it for around 14 days every 3 months. It is recommended for women with irregular periods.

Role of HRT in Mental Health and Treating Mood Disorders

Research says that between 15% and 50% of women experience depressive symptoms during the menopausal transition. While some women may feel better after taking estrogen-only HRT as a result of hormonal stability, for others, a combination of estrogen and antidepressant is needed to feel better.

estrogen treatment is also very effective in improving sleep in women who experience night sweats. And a good night’s sleep naturally helps with mood swings and mental balance. Therefore, HRT coupled with exercise, meditation, avoidance of caffeine and alcohol, can help with anxiety and depression.

Many a time, women may not realize that the changes in their mental health and mood are due to the onset of perimenopause or menopause. But it is, in fact, all about the hormonal balance.

So be aware of the menopausal symptoms that may arise and seek medical help if you find them difficult to cope with. Don’t suffer in silence! And for starters, do not blame yourself for how you feel.

Taking hormone replacement therapy is now being normalized as it provides immense benefits, especially if you are experiencing bothering menopausal symptoms. You can also learn how to adapt your lifestyle to make yourself feel comfortable through the menopausal phase. Simple things like hydration, maintaining lower room temperature, using cotton sheets, and layering your clothes can make a whole lot of difference!

Krishma Patel is the co-founder and the Superintendent Pharmacist at MedsNow – UK online pharmacy. She is passionate about showcasing the integral function community pharmacies can play in supporting the healthcare system and the NHS by providing patients with high quality, safe and discreet access to healthcare at their convenience. Krishma is also the Director and the Superintendent Pharmacist of Enimed Ltd.