Menopause and HRT: What you need to know!

Menopause and HRT: What you need to know!

Menopause and HRT: What you need to know!

Menopause and HRT 

When a teenage girl goes into menarche, three hormones start to become cyclical over a monthly period as opposed to static. After a few decades, this cycling of her hormones, once again returns to a new rhythm. These three hormones are oestrogen, progesterone and testosterone.

The peri-menopause is the period of time during which these fluctuating are at their most intense and can be characterised by a whole raft of different symptoms.

The Major Symptoms that a drop in oestrogen causes are:

  1. Hot flushes and sweats
  2. Dryness of the vagina
  3. Aching joints and muscles
  4. Palpitations
  5. Mood changes: irritability, depression and tearfulness.
  6. Bladder weakness
  7. Brain fog
  8. Skin crawling
  9. Light periods
  10. Loss of libido
  11. Insulin resistance and increased belly fat, sugar cravings
  12. Reflux and irritable bowel syndrome
  13. Increased stress perception.



The Major Symptoms of a falling progesterone are:

  1. Insomnia or poor sleep quality
  2. Muscle tension
  3. Muscle aches
  4. Irritability, increased nervous tension
  5. Heavy periods
  6. Sore breasts
  7. Anxiety
  8. Fluid retention
  9. Irregular periods (shortening of the cycles)
  10. Bleeding gums


The Major Symptoms of sub-optimal testosterone

  1. Weight gain
  2. Muscle loss
  3. Loss of libido or anorgasmia
  4. Loss of vitality
  5. Fatigue


What you may notice is that there is an over-lap of symptoms associated with the changing hormone levels, this is because of their significant inter-relationships.  


Hormone replacement therapy (HRT) is the use of replacing these hormones to reduce some of the symptoms associated with the menopausal transition. However, even though this seems like a reasonable thing to do, for a woman who is experience significant poor mental and physical health during this time, there still remain a lot of misunderstanding, controversy and misalignment amongst doctors regarding this intervention.


To understand why this is the case, we need to look at what happened in 2002. Prior to this, the use of HRT was widespread and in fact encouraged by most doctors for women around this age. At that time, HRT was thought to be a treatment that helped to protect women from heart disease, osteoporosis, cognitive impairment and stroke and of course offered them relief form distressing menopausal symptoms such as hot flushes, insomnia and mood changes. However, a media release reported on the results from the large study called the Women’s Health initiative (WHI) published in the JAMA (Journal of American Medical Association), which reported an increase in breast cancer, stroke, blood clots and heart disease in the hormone replacement users. The trial was prematurely called off, and millions of women across the world stopped taking HRT almost at once.

Since then,  researchers have started to review the data collected from the WHI and found some interesting anomalies that likely contributed to the poor results seen in the active cohort. Firstly, the average age for starting the HRT treatment arm was 63 years of age. The normal starting age for HRT is around 50-52 years or within 5 years from the cessation of the regular menses. The second issue was the use of synthetic hormones. The estrogen replacement used was called Premarin, this is an estrogen-like molecule that is extracted from pregnant horses. The progesterone replacement used was again a synthetic version, called progestogen. Testosterone was not given as part of the trial.

What was found was that the increased incidence of breast cancer was attributed to the synthetic progestogen, rather than the oestrogen and the increases in incidences of stroke and blood clots were thought to be due to the fact that the oestrogen given, was both not identical to human oestrogen and it was given orally. 

Research has begun again, for women entering into this period of their lives and doctors across the world are reviewing their practices, and many are only choosing to use bio-identical hormones in their prescriptions. Natural progesterone and natural estrogen are used instead of the synthetic variations, which is thought to give the woman back some of her declining levels in small doses to reduce symptoms, and long-term negative impact of the declining levels of these 3 hormones. In addition, oestrogen therapy is given via the skin, this further reduces the dose needed for effectiveness and lower the risk of side-effects.

Utilising the natural hormones, better understanding of the physiology and delivering system, alongside supporting women in other key longevity habits such as reducing belly fat, support good sleep quality, bone density, and improving metabolic energy may counteract some of the potential negative impacts. For a full summary of the research and handout on the risks and benefits of HRT: click this link. More research is clearly needed to confirm the best options regarding timing, dosing, and long-term impacts.


An Australian Researcher by the name of Dr Susan Davies is world renowned for her research into testosterone replacement for women during and after menopause. Testosterone is a key hormone for women which is commonly deficient during the peri-menopausal/menopausal period and the impact of this can be widespread. Issues such as decreasing libido, unsatisfactory orgasms, hypo-arousal and lower muscle mass, strength and vitality are common during this time, leading to issues with interpersonal relationship, personal levels if enjoyment and sexual satisfaction, self confidence, and  metabolic issues associated with changing body composition. This can have long term impacts for optimal metabolic health which may then lead to increased cardiovascular disease risk, and type 2 diabetes. Replacement of testosterone may be option if it is consistently low. Please talk to your doctor about whether HRT is a safe and healthy option for you. 

Common HRT preparations that use natural oestrogens:

  • Estrodot
  • Sandrena
  • Estrogel
  • Estro-combi

Progesterone preparations:

  • Prometrium
  • Estro-combi

Testosterone preparations:

  • Androfeme