Hormones and Hormone Therapy (HT)

Hormone production

A woman produces many different natural female hormones including:

  • Oestrogen
  • Progesterone
  • Testosterone

Oestrogen and progesterone are produced in the ovaries during a woman’s reproductive life. Levels of these hormones fall dramatically at menopause until, in the post-menopausal years, small amounts of each are produced by the adrenal glands instead of the ovaries.

Testosterone is produced by the adrenal glands and the ovaries. Levels decline gradually over a woman’s life, but are significantly reduced in women who have had both ovaries removed.

Hormone Therapy (HT)

Hormone Therapy (HT) or Hormone Replacement Therapy (HRT) is the giving of the female hormones oestrogen and progesterone, and sometimes testosterone.

Oestrogen and progesterone

Oestrogen is the main hormone prescribed to relieve menopausal symptoms and for women who have had a hysterectomy, this is all that may be needed.

In women who still have their uterus, oestrogen alone can overstimulate the cells lining the uterus causing an increased risk of endometrial cancer (cancer of the uterus). This risk is neutralised by giving the hormone progesterone along with the oestrogen. It is given in a synthetic form known as ‘progestin’ or ‘progestagen’.

Testosterone

Women experiencing loss of libido, lack of energy and ongoing fatigue, even when taking oestrogen therapy, sometimes benefit from low dose testosterone replacement, however this is an area of ongoing research to further clarify clinical guidelines.

Using HT

HT is most often prescribed as tablets but there are also patches, a skin gel, implants and vaginal preparations such as creams or pessaries (pellet). What suits one does not suit all, and dosages and methods of administration vary according to each woman’s needs and response to HT. Changes may be required before a satisfactory method and dose is found for each woman, and these changes are made under the close supervision of the health practitioner. It can sometimes take up to six months to find the right combination.

Tablets

Oestrogen and progesterone are available separately or as combined tablets like the contraceptive pill packs. Dose and types vary.

Patches

Patches can be an alternative to tablets and the hormones are absorbed through the skin. Some patches contain oestrogen others are a combination of both oestrogen and progesterone. Sizes vary according to dose.

Gel

Oestrogen is also available as a gel. Progestin should be taken in tablet form or used as an IUD by women who have not had a hysterectomy. Gel comes in single dose sachets and is used daily by rubbing into the skin.

Creams and pessaries (pellet)

Creams and pessaries (pellet) are used locally by inserting the cream or pessary containing oestrogen into the vagina. They are mainly used by women who have vagina or bladder symptoms.

Implants

Implants are inserted under the skin under local anaesthetic by a doctor and are about one centimetre long.

Usual forms of progesterone and testosterone

A progestin may be prescribed as a tablet, intrauterine device (IUD) or a patch.

Testosterone is administered either as an implanted pellet or cream (see Libido) and is usually prescribed short-term.

As a general rule when using HT:

  • Start low
  • Go slow
  • Review often

As individual needs may vary it is important to talk to your health practitioner about what is right for you.

HT benefits and risks

There are benefits and risks associated with using HT and research continues in this area.

Gathering information and talking with your health practitioner can assist you in making an informed decision.

Useful resources

  • Hormone Therapy Benefits and Risks – Short-term use of hormone therapy (HT) may be useful for women experiencing more severe symptoms of menopause.
  • Hormone Therapy Side Effects – Some women may experience nausea, fluid retention, breast enlargement and discomfort, particularly during the first few months of taking HT.