a guide to hormone replacement therapy (HRT)

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  • As Davina details her own HRT routine.

    Ever heard of hormone replacement therapy? If you hadn’t prior to this week, you may now have given that there’s currently a nationwide shortage in the UK.

    While around a million women in the UK take HRT, Davina McCall opened up a more public conversation around it last year with her show, Sex, Myth and the Menopause, during which she detailed her own experience with the treatment.

    HRT has got a bad rap over the years – while the medication is fully evaluated through research and clinical trials, it’s still sometimes shunned thanks to a 2002 study which warned of the risk of breast cancer – Davina maintains that HRT has “changed [her] life” for the better.

    Now, she wants her experience to help others. Urging women to seek out “the correct information,” the presenter shared her view that the information inside the HRT packet, which can put many women off the treatment, is “wrong”.

    “Many women get the prescription and then they throw it in the bin because they read all the information and they get frightened,” Davina shared. “So get the correct information and then if I were you, I would go on it pronto if you feel that it’s right for you, because it has revolutionised my life.”

    Davina also feels that the stigma around HRT is unnecessary. “It’s interesting how people make you feel like it’s something that you’re doing in order to try and ‘stay young’ or it’s a cop-out, something weak,” she said. “But all you’re doing is replacing the hormones that have gone.”

    The average age for the menopause in the UK is 51 and is defined as the absence of menstruation for 12 months, but the period leading up to the this is called the perimenopause and can last for many years. “We now understand that the transition into menopause is a gradual process and women can have a rollercoaster ride of fluctuating hormones that can really impair their quality of life,” shares Aziz Scott.

    Here, two doctors explain what hormone replacement therapy is, how it works, what the common side effects are and how to know whether it’s the right option for you.

    Hormone replacement therapy: your guide

    What is HRT? 

    HRT is a treatment – commonly a tablet or skin patch – that works by replacing the hormones that decline during the menopausal period, shares Aziz Scott. As doctor Martin Kinsella, founder of BioID Health, explains,”as the name suggests, the medication replaces female sex hormones (oestrogen and progesterone), which naturally decline during menopause.”

    By doing so, you ease menopause symptoms by replacing the hormones that naturally decline with age.

    Why is this important? Simply put, because each of our hormone has a specific function and further, symptoms related to its deficiency. “For example, oestrogen deficiency causes hot flushes, night sweats, and vaginal dryness,” shares the doctor.

    “Progesterone deficiency links in with insomnia and anxiety while testosterone replacement will improve energy and libido. Plus, all of these hormones are neurosteroids and can have an impact on brain function, specifically memory – a common menopausal complaint.”

    Hormone replacement therapy: Top view of various pills and tablets on the pink background

    Are there different types of HRT?

    Yes, there are. “There are essentially two types of HRT options; combined HRT or oestrogen-only,” Kinsella shares. “Combined HRT is a prescription that replaces both, oestrogen and progesterone, in order to regulate hormone levels. Oestrogen-only HRT is typically only prescribed to women who have had a hysterectomy (had their womb removed).”

    There are also many different ways of taking HRT. Because there are so many, expect finding the right combination for you to take time.

    They span:

    • Tablets
    • Skin patches
    • Gels
    • Vaginal creams
    • Pessaries
    • Rings.

    Fun fact: as time has gone on, science has evolved which means we now have bioidentical hormone replacement therapy (BHRT), too. “Unlike standard HRT, which is derived from synthetic hormones, BHRT is created from plant sources that are similar to the hormones your body naturally creates,” explains Kinsella.

    Side effects of HRT

    Side effects relating to estrogen replacement can be:

    Those relating to progesterone can be:

    • Fluid retention
    • Mood swings.

    Similarly, testosterone can cause:

    However, with the correct regime to suit your needs, side effects last only a few weeks, shares Aziz Scott. “Symptoms can be minimised,” she reassures.

    I’m not sure whether I should take HRT – help! 

    Short answer – it’s up to you. “Most women notice a huge improvement in quality of life with HRT with fewer symptoms, improved hot flushes and night sweats, improved sexual health and libido and better mood,” shares Aziz Scott. “There are also well researched long term health benefits such as decrease in osteoporosis risk, improved cardiovascular health and a decreased risk of Alzheimer’s dementia.”

    As Kinsella explains, there are pros and cons including:


    • Better quality of life
    • Alleviated symptoms such as lack of sleep, fatigue, hot flushes and more
    • Osteoporosis prevention.


    • Unpleasant side effects such as bloating, leg cramping, headaches, indigestion and more
    • Increased risk of blood clots and strokes.

    Bottom line: the doctor reckons that the benefits of HRT usually outweigh the risks for most women. “The risks are usually small, depend on the type of HRT you take, how long you take it for and your own health risks,” she goes on.

    Hormone replacement therapy: Gels

    Can HRT cause breast cancer? 

    Thanks to the 2002 study, women often worry about the risk of breast cancer. So what does the doctor reckon? “Recent research shows there is little or no change in risk of breast cancer if you take bioidentical or bodyidentical oestrogen and progesterone,” she explains.

    “In fact, other risk factors such as obesity, lack of exercise and smoking have a greater impact,” she warns. “But regular breast screening to check for breast cancer is vital.”

    On that note – Kinsella shares that the taboo surrounding HRT has been around for years. “As we’ve established, no treatment or form of medication is completely risk-free,” he shares. “The key is to finding a treatment that gets to the root of the problem and works for you and your body.”

    Davina’s HRT routine: oestrogen patches and more

    Sharing her morning HRT routine on Instagram, Davina detailed the gels, creams and patches that she uses post-shower every day. “A big part of my morning routine is my hormones and I thought to demystify it a little bit I would show you how you apply them,” she says.

    Talking about her menopause documentary, she says: “I don’t think I’ve ever worked on a project that has affected me so deeply. She said that she regularly got choked by “deep frustration and anger at how we are failing women. This film isn’t just for menopausal women, it’s for their partners, their fathers, their brothers, and their sons. We’re all in this together. I used to think that menopause was an age thing and now I realise it’s a woman thing. For far too long, there’s been a shroud of embarrassment, shame and fear around this topic, and this is where it stops!”

    Her usual routine includes:

    1. An oestrogen patch 2x a week

    The first thing you see Davina apply is remove a clear “hormone sticker” on her hip called Estradot. She replaces the small plaster twice a week. “It does leave a bit of sticky stuff [like any plaster] but I thought you should see the ups and downs. I wanted you to see it warts and all.”

    She switches hips when she replaces the sticker. “We use stickers because they are transdermal [absorbed through the skin as opposed to a tablet] Transdermal is important because it’s a much better way to take HRT,” she shares.

    FYI – the patch is translucent “so whatever skin colour you are it goes clear,” or so she reassures.

    2. Oestrogen gel – daily

    Davina also uses a clear transdermal gel called Oestrogel. She applies it by rubbing it into her upper arm and does so to boost her oestrogen levels.

    Fun fact: “Oestrogen these days is plant-based,” or so says Davina.”It’s made from yams. They are very, very different from the hormones that were taken back in the day.”

    3. Testosterone cream – daily

    Next, Davina rubs a Testosterone cream into her thigh, but Davina shares that this particular hormone is less commonly prescribed and not widely available via prescription on the NHS.

    “I think you can get this if your libido is on the floor,” shares the presenter. “But this is more than just about sex drive. Did you know that testosterone is an enormously important women’s hormone as well? My testosterone was low and I take a pea-sized amount.”

    “By the way, taking testosterone does not make you or a penis or testicles or get hairy or anything like that. I am not taking extra testosterone I am just replenishing my levels to where they should be.”

    4. Progesterone – coil

    As we’ve explained, most hormone replacement therapy combines oestrogen and progestogen. While many women take a progesterone pill called Utrogestan, Davina doesn’t as she has a coil which provides it. “The progesterone part of my HRT, I get from the Mirena coil,” she shares with her followers.

    On her daily routine, she says: “I know you must think it’s a faff, but I do feel normal again and dare I say sometimes I feel better than I have done in years and years. So for me, the faff is worth it.”

    Considering trying HRT yourself? Aziz Scott advises you seek medical advice from your GP – ideally one who has expert knowledge in the menopause, she shares. “Remember to ask for bodyidentical or bioidentical HRT, as we know this is the best option. Vaginal oestrogen creams are also very helpful for vaginal health and can be used safely,” she concludes.

    And remember, your prescription will be bespoke and unique to your’ individual needs. “They’re designed to help the body cope with the changes, ultimately alleviating many of those unpleasant and difficult symptoms,” concludes Kinsella.

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