Menopause is when the female hormones oestrogen and progesterone reduce in the female body causing a variety of possible unpleasant symptoms, including;

• Vaginal dryness
• Mood swings
• Hot flushes

Hormone Replacement Therapy treatments (HRT) are designed to replace these hormones, reducing the uncomfortable symptoms of menopause.
During menopause, a woman’s ovaries stop releasing an egg every month causing her to no longer have her monthly menstrual (period) cycle and will no longer be able to have any children.

This usually happens between the ages of 45 and 55. The average age in Ireland for a woman to reach menopause is 51.

Perimenopause is when you have symptoms before your periods have stopped completely. Symptoms can start 7 years before your periods stop.

Early menopause happens when your periods stop before the age of 45. It can happen by itself or as a side effect of some treatments.

Talk to your GP if you’re under 45 and your periods are infrequent or have stopped.

The reduction in oestrogen levels results in many of the characteristic symptoms of the menopause. Short-term symptoms that may continue for 2 to 5 years include hot flushes/flashes, night sweats, emotional disturbances (e.g., mood swings, irritability, depression, and anxiety), loss of libido (sex drive), insomnia/disturbed sleep, headaches, and tiredness.

Over the longer term, oestrogen deficiency results in skin and hair to become drier and thinner, including that of the vagina which makes intercourse painful. It also causes more frequent urinary infections and need to pass urine; urinary incontinence; bones to become thinner (osteoporosis); and an increased risk of heart and blood vessel disease. Low levels of progesterone are similar to those of oestrogen deficiency. They include infertility, dry skin, emotional disturbances, low libido, tiredness, headaches, and weight gain.

HRT is usually a combination of oestrogen and synthetic progesterone (progestin). The preparation and type of HRT suitable for any individual woman will depend on their preference and circumstance. All HRT provides an oestrogen dose into the bloodstream. However, oestrogen is usually given with progesterone to prevent an increase in the womb lining, which increases the risk of womb (endometrial) cancer.

HRT is available in many preparations such as tablets, skin patches, implants, sprays or in a specific vaginal preparation (vaginal creams, pessaries or rings). There are also different types of HRT, including oestrogen only HRT (for women without a uterus following hysterectomy), cyclical or sequential HRT (for women who still menstruate) or continuous combined HRT (for postmenopausal women).

The lowest effective oestrogen dose is usually taken at the start of treatment, and can be increased or the HRT type changed at a later date if ineffective. Long-term use (over 5 years) is generally not recommended. Stopping HRT after 2 to 5 years is appropriate once the menopausal symptoms have subsided. A gradual reduction in dose to prevent a recurrence of symptoms may be advised. Long-term symptoms of oestrogen deficiency such as vaginal dryness and osteoporosis may need continuing treatment with oestrogens or other therapies.

The most common side effects of HRT include fluid retention, bloating, breast tenderness and swelling, headaches, nausea and digestive disturbances, mood swings and depression. Weight gain may occur in women during the menopause, regardless of whether HRT is taken or not.

While HRT can reduce the risk of osteoporosis, and colon and rectal cancer, its use long term can increase the risk of breast and uterine (endometrial) cancer, stroke, and blood clots in blood vessels of the legs (deep vein thrombosis) and lungs (pulmonary embolism).

Useful links: https://www2.hse.ie/conditions/menopause/
https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/