Hormone Replacement Therapy

What is Hormone Replacement Therapy (HRT) for?

Hormone replacement therapy (HRT) is used to describe preparations that contain the two female hormones, estrogen and progestogen, that are given together to relieve bothersome symptoms of menopause.

Symptoms of menopause include hot face, neck and chest (“hot flushes”), night sweats, vaginal dryness and low mood. The decrease in estrogen may also lead to a condition called osteoporosis, where the bones become thinner, weaker and easier to break. Using estrogen alone may cause abnormal thickening of the uterus (womb) lining – hence those with an intact uterus require an additional female hormone, progestogen, to prevent this.

Progestogen may be combined together with estrogen in one tablet. It may also be prescribed separately for a specific duration each month.

How should I take or use Hormone Replacement Therapy (HRT)?

• Do not stop taking your medication without checking with your healthcare professional.
• You should take this medication after food.

There are different types of HRT and the way to take these medications depends on the HRT that you have been prescribed. Some brands have different coloured tablets which have to be taken in a certain order.

The following are some commonly used HRT regimens: 

• Estrogen only HRT e.g. Premarin® / Estrofem® / Progynova®
• You should take one tablet daily without break, preferably at the same time every day.
• If you have an intact uterus and are still menstruating, your doctor would prescribe a separate progestogen hormone as well to take for a specific duration (usually 10 – 14 days) each month. In this case, you will experience a withdrawal bleed (menses) after finishing the progestogen tablets.

• Continuous combined therapy e.g. Activelle®, Femoston® Conti 1/5
• You should take one tablet daily without break, preferably at the same time every day.

• Continuous Estrogen and Cyclic Progestogen Therapy e.g. Femoston® 1/10 and Femoston® 2/10
• These types of medications usually have 14 tablets containing estrogen-only, and 14 tablets containing estrogen and progestogen, in one pack.
• You must take the tablets in the correct order.
  
• Take one tablet daily without break, preferably at the same time every day.
• When a pack is finished, the next pack should be started without any break.
• You will experience a withdrawal bleed (menses) once a month after completion of each pack.

• Triphasic therapy e.g. Trisequens®
• These types of medications contain estrogen-only tablets and combined estrogen and progestogen tablets in varying doses, in one pack.
  
• You must take the tablets in the correct order.
  
• You should take one tablet daily without break, preferably at the same time every day.
• When a pack is finished, the next pack should be started without any break.
• You will experience a withdrawal bleed (menses) once a month.

• Cyclic Estrogen and Progestogen e.g. Progyluton®
• These types of medications contain estrogen-only tablets and combined estrogen and progestogen tablets, in one pack.
  
• You must take the tablets in the correct order.
  
• You should take one tablet daily for 21 days in a row, preferably at the same time every day. After completion of the pack, there will be 7 days where you do not need to take any tablets (7-day tablet-free interval), during which you will experience withdrawal bleeding (menses).
  
• Start taking your next pack of medication after the 7-day tablet-free days, even if you are still having menses.
  

What should I do if I forget to take or use Hormone Replacement Therapy (HRT)?

• Take the missed dose as soon as you remember. Then take your next dose at the usual time. Do not take two doses to make up for the missed dose.
• You may have vaginal bleeding or spotting if you forget to take more than 1 tablet. Please ask your doctor for advice.

What precautions should I take when taking or using Hormone Replacement Therapy (HRT)?

This medication is NOT meant to be as a birth control method and would not prevent you from getting pregnant.

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.
  
• You are pregnant, planning to become pregnant, or breastfeeding.
  
• You are taking any other medications, including supplements, traditional medications and herbal remedies.
• You have a history of or current medical conditions such as liver problems, stroke, heart disease, blood clots, migraine headaches, epilepsy, diabetes mellitus or cancer.
  
• You are going for a surgery. You may need to stop taking HRT for a couple of weeks before the surgery.
  

What food or medication should I avoid when I take or use Hormone Replacement Therapy (HRT)?

Some medications including antibiotics, antifungals and St John’s wort may affect how HRT works or be affected by HRT. Please inform other healthcare professionals about the HRT you are taking if you are seeing them for other medical conditions.

What are some common side effects of Hormone Replacement Therapy (HRT)?

• Breakthrough bleeding and spotting (menstrual bleeding outside of menses period)
  
• May occur during the first few months of treatment or if doses are missed. If it continues after the first months of treatment, appears after some time during therapy, or continues after treatment has been stopped, ask your doctor for advice.
  
• Mood changes
• Take medication at the same time every day to avoid huge changes in the hormone levels in your body, which can lead to mood changes.
• Breast tenderness, slight bloating or fluid retention
• Nausea and vomiting
• Take the medication after food to reduce these side effects.
  
• Headache
• You may take Paracetamol to manage headaches. Do make sure that you are drinking enough water.

Taking HRT increases a woman’s risk of developing blood clots and breast cancer. However, these are rare and the doctor would have evaluated and weighed its benefits over risks before making the recommendation. Please discuss with your doctor if you have any concerns.

• The symptoms of blood clot include one or more of the following:
• Any unusual sudden cough, breathlessness or difficulty in breathing
• Severe pain in the chest which may reach the left arm
• Severe pain in legs or swelling in either of your legs
• Weakness or numbness in any part of your body
• Change in your speech, including slurring of words
• Change in your senses of hearing, smell or taste
• Vision changes such as loss of vision/ blurred vision

It is also advisable to regularly check your breasts while you are on HRT.  If you notice any unusual changes, please see your doctor immediately.

Other rare but serious side effects that you may or may not experience include:

• Unexpected, heavy or longer than usual menstrual bleeding
• Dark urine or light coloured stools, nausea, vomiting, loss of appetite, stomach pain, yellowing of your eyes or skin
• Bothersome mood changes

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body
  

If you experience any of these side effects/ symptoms, you should stop your medication and see your healthcare professional immediately.

How should I store Hormone Replacement Therapy (HRT)?

• Keep away from children
• Keep in a cool, dry place, away from direct sunlight

How do I throw away Hormone Replacement Therapy (HRT) safely?

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.