Signs that you should get hormone replacement therapy (HRT)

Menopause is a natural part of women’s health and development. It’s a phase that occurs 12 months after a woman’s last period. Up to that point, women experience a multitude of different symptoms known as the menopausal transition (perimenopause). This phase is caused by a hormonal imbalance, as your hormone levels naturally begin to fluctuate and eventually decline.

What causes menopause?

Gradually, your body begins to produce less oestrogen (estrogen), the hormone that is responsible for the female reproductive organs as well as many other processes in the body. Your body also stops producing progesterone (the hormone that regulates the menstrual cycle) and testosterone (male hormone that regulates oestrogen production). These hormone changes are what causes the symptoms most commonly associated with perimenopause, and are usually the defining signs.

For most women, the perimenopause starts between the ages of 45 and 55. In rarer cases, some women start early menopause before the age of 30 either naturally; from having a hysterectomy (surgical procedure to remove the womb); or from the surgical removal of the ovaries due to ovarian cancer or severe endometriosis.

Below, are the main signs of menopause. Not all women experience them, and how badly you experience them may depend on your lifestyle (your BMI, whether you smoke or drink), when your symptoms started and your family history.

The most obvious sign of menopause is changes in your menstrual cycle. This occurs because your progesterone levels change, the hormone that prepares the endometrial lining (uterus lining) for a fertilised egg.

As you start going through menopause, you may notice several irregularities in your cycle before your periods inevitably stop, including:

• your periods happening closer together
• heavier bleeding
• spotting (light bleeding in between periods)
• your periods lasting longer (more than a week)
• bleeding resumeing after a long time

One of the most common signs of menopause is hot flashes or flushes. They are believed to be caused by the decrease in oestrogen which, in turn, makes your hypothalamus more sensitive (the part of your brain responsible for body temperature).

This means that when your hypothalamus thinks your body temperature is high, it causes a hot flush to attempt to cool you down, even though your body temperature is normal.

You may experience the following during a hot flash:

• sudden feeling of warmth that spreads through your chest, neck and face
• a flushed appearance (red, blotchy skin)
• raised heartbeat
• sweating on your upper body
• a chilled feeling once the hot flash ends
• feelings of anxiety

A single episode typically lasts for a minute or two, but can last for up to 5 minutes for some women. They can occur at any time, including during the night (night sweats) but how often they occur depends on the individual.

Several changes can occur to your vaginal and sexual health. The main symptom that occurs is vaginal dryness. This happens because oestrogen is responsible for keeping the vaginal lining elasticated and lubricated.

This causes several complications in menopausal women, including:

• soreness and itching in and around your vagina
• pain or discomfort during sex
• needing to urinate more than usual
• recurrent UTIs (urinary tract infections) also known as cystitis

This in turn affects your sex drive and affects many women’s self-esteem. Thankfully, there are many over-the-counter and prescription treatments or creams available to help with vaginal dryness.

Hot flashes and other uncomfortable symptoms also affect the sleep of perimenopausal women. It is the leading cause of insomnia in women in their 40s - 50s, with research Trusted source PubMed Government Source Database of Biomedical Research Go to source finding over 40% of menopausal women experience sleep disturbances.

The main cause is the night sweats from hot flashes, as many wake up suddenly from a sudden feeling of hotness and sweating. This affects many women’s sleep in the long-term, causing them to feel fatigued throughout the day and for the majority of time.

Research Trusted source PubMed Government Source Database of Biomedical Research Go to source has also shown that lower progesterone levels puts menopausal women at a higher risk of OSA (obstructive sleep apnea). This is where you experience temporary pauses in breathing as your airways can’t relax whilst you sleep.

Depression, irritability and general mood swings are very prevalent during menopause. One study Trusted source PubMed Government Source Database of Biomedical Research Go to source found that around 60% of menopausal women suffered with chronic depression.

Mental health problems can be attributed to hormonal fluctuations, similar to that experienced by women during PMS (premenstrual syndrome), but also from the discomfort from the symptoms and sleep problems.

Grief is also a very common emotion during menopause, whether it’s grieving the loss of your fertility, the symptoms or the effect it has on your daily life and relationships.

Unfortunately, the health problems don’t stop after perimenopause. Postmenopause refers to the stage after 12 months after your last period. Some women may experience symptoms of menopause after perimenopause, however there are other health complications that occur.

Heart health

Postmenopausal women are at a higher risk of cardiovascular health problems. The hormone oestrogen is responsible for many processes in the body, it also can offer some protection against coronary artery disease, high cholesterol and fatal conditions such as heart attacks and strokes.

This is because oestrogen prevents plaque (fatty substance) from building up in the arteries, and once your body starts producing very little oestrogen, it can put you at a higher risk of heart disease and other cardiovascular problems.

As you get older, your arteries can also become stiffer from high blood pressure which also contributes to the increased risk of cardiovascular disease.

Bone health

In addition, many postmenopausal women struggle with bone pain and bone loss. This is because oestrogen and testosterone are both responsible for bone density and bone repair. Once the levels drop post menopause, women are more at risk of bone fractures and breaks. This is a condition called osteoporosis.

Unlike when your mother or grandmother were going through menopause, there are many treatment options accessible to you to help alleviate the symptoms of menopause. HRT is a form of hormone therapy specifically for the treatment of menopause.

Menopausal hormone therapy is clinically proven to alleviate all of the main signs of menopause and significantly reduce your risk of osteoporosis and cardiovascular disease post menopause. Another benefit of HRT is that it is available in many different formats, meaning there is most likely a form of HRT that works best for you.

Whilst there are known side effects and some risks of HRT, certain myths of HRT causing breast cancer, weight gain or blood clots can cause women to not take HRT. It’s important to remember that you are no at greater risk of experiencing these complications than a woman who is not taking HRT. Additionally, the benefits often outweigh the risks. You should talk to your doctor or healthcare provider if you have any questions or concerns.

HRT are available as tablets, skin patches, implants and gels and they contain synthetic versions of the sex hormones in our body. This type of HRT is often referred to as rBHRT (regulated bioidentical hormone replacement therapy). Some methods of HRT contain only estradiol (oestrogen), but some also contain progestin or progestogen (progesterone) which you take simultaneously or cyclically.

For more information on the menopause, HRT and how to purchase HRT check out our dedicated page on this topic. At euroClinix, you can purchase regulated HRT discreetly online and get it delivered right to your door.