Women are protected before the menopause from heart disease and bone softening due to a hormone called Estrogen , also spelt oestrogen . After the menopause in the 40s or early 50s the level of this hormone falls significantly and the incidence of heart problems and fractures due to soft brittle bones tends to rise steeply unless the falling levels of estrogen are replaced by a pill or via skin patch .
There has been some concern that breast cancer and blood clots in the legs might rise , but most studies do not show it and others report a very miniscule addition if at all , from 45 per 1,000 in non users to 57 after 15 years of hrt in users meaning that 955 women not on hrt will not get breast cancer while 943 on hrt wont get it .Only women who have had the rare estrogen sensitive breast cancer should not take it . An even more miniscule rise from 11 per 100000 women to 27 of blood clots in the legs or lungs have been shown in the odd study ie of 100,000 women who take hrt , 99,973 wont get a blood clot .If there has been a previous blood clot within a year then its advisable to wait .
Estrogen tends to stimulate the lining of the womb while another hormone progestrone reduces it , so both are given to keep the balance . Most women report increased well being right from the start but a few may have temporary side effects for a few weeks of breast tenderness and nausea (due to progestrone in the pills and the pill brand may be changed ) and some months of scanty periods .
The common preparations using natural estrogen doctors may recommend are
1. Combined tablet , consisting of estrogen for its positive effects and progestrone to stop too much stimulation . Examples are Kliofem taken one every day.
b. Combined tablet but the progestrone given only every three months to cause a period - Tridestra
2. Combined patch , put on the body and changed twice a week . Fem seven needs only one change a week.
3. Estrogen only tablet if the womb has been removed for some reason as then there is no risk of stimulating growth in the lining of the womb.
4. Estrogen only patch.
5. Estrogen tablet daily supplemented by a vaginal suppository of progestrone gel (Crinone)for alternate days for 12 days of cycle .
6.Estrogen tablet with a progestrone IUD ( Mirena) effective for five years.
7. Estrogen tablet with provera as the progestrone .
Evista (Raloxifene) which is selective for bone and doesnt stimulate the womb or breast (serm - selective estrogen receptive modulator) but they are less effective for hot flushes .
Non hormonal pill to help the bones eg Livial .
HRT can be continued for life .