Hormone replacement therapy: your complete expert-led guide, plus Davina's daily routine

The demand for hormone replacement therapy (also known as HRT) has dramatically risen over the past seven years with around one million women in the UK using HRT for their menopausal symptoms. Davina McCall opened up a more public conversation around it last year with her startingly honest Channel 4 documentary, Sex, Myth and the Menopause, during which she detailed her own experience with the treatment.

After Davina put an estrogen HRT patch on camera, GPs reported women coming in and saying; “I’ll have what Davina’s having”. Some, have described HRT as life-changing. But historically, HRT has had a bad rep – mainly due to a somewhat misleading 2002 study which warned of the risk of breast cancer. But safe and effective HRT is now readily available, and 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 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 Dr Ghazala Aziz-Scott from The Marion Gluck Clinic.

Here, three 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. It is estimated that as many as 85% of women going through the menopause experience menopause-related symptoms.

Why is this important? Simply put, each of our hormones 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 impact brain function, specifically memory – a common menopausal complaint.”

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:

• Breast tenderness
• Bloating
• Headaches
• Nausea.

Those relating to progesterone can be:

• Fluid retention
• Mood swings.

Similarly, testosterone can cause:

• Acne
• Hair loss.

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.

Is HRT affordable?

“HRT can be obtained through the NHS and you only pay one prescription charge per year now, so very affordable,” explains Dr Tania Adib, gynaecologist, menopausal hormone specialist and founder of Luminosa London. 

Current prescription charges on the NHS are £9.35 per item – but earlier this year, the government announced they were taking action to increase access and reduce the cost of HRT, so women can pay a one-off charge equivalent to two single prescription charges, currently £18.70, for all their HRT prescriptions for a year.

Due to be implemented from April 2023, this prepayment certificate essentially means that women will be able to access HRT on a month-by-month basis if need be, which will both ease pressure on supply and keep the cost of HRT low. 

Isn’t HRT available over the counter now?

Yes! Earlier this year the UK’s medicines regulator, MHRA, reclassified one specific form of HRT – Gina 10 microgram vaginal tablets (Estradiol) – making HRT available to buy over the counter for the first time ever. All other HRT, including other kinds of HRT tablets, will still require a prescription and a consultation with your doctor – but the fact that Boots will sell Gina over the counter (as well as online) is a huge step forward when it comes to prioritising female health and increasing women’s access to treatment. In a press release, Boots announced Gina is now available as a pack of 24 vaginal tablets for £29.99  – which works out to £2.50 per week – and will be stocked at all Boots stores by the end of October.

What to expect if you come off HRT

There's no limit on how long you can take HRT – you can, in theory, take it for life, but it’s always best to discuss with your GP. According to the NHS, most women stop taking it once their menopausal symptoms pass, which is usually after a few years. But as Dr Adib points out, if you decide to stop HRT, “symptoms can return as before or worse, so reduce slowly over a number of weeks”.  

The National Institute for Health and Care Excellence (NICE) tells us that there’s no long-term difference between stopping gradually or stopping abruptly, but symptoms may return less quickly if you stop gradually.

“Coming off HRT is very variable,” adds Dr Adib. “The menopause societies around the world all recommend continuing with HRT lifelong, as long as the benefits outweigh the risks, so I would encourage everyone to continue with their HRT.”

What are the alternatives to HRT?

For those who cannot or do not want to take hormones, you can tackle menopausal symptoms in a more holistic way. From regular exercise and a healthy balanced diet to cutting back on caffeine and alcohol, there are lifestyle measures that can help reduce some menopausal symptoms.

“The best way to deal with menopause symptoms is a rounded, well-balanced approach to your lifestyle, taking a range of different aspects into consideration such as diet and nutrition, daily habits, sleep quality and stress levels,” says Dr Adib. 

“Balancing your hormones and easing your symptoms doesn’t always need to be complicated. It just requires knowledge, the decision to prioritise your own health and wellbeing, and a change to old habits that may no longer be serving you.”

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 a decrease in osteoporosis risk, improved cardiovascular health and a decreased risk of Alzheimer's dementia.”

As Kinsella explains, there are pros and cons including:

Pros:

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

Cons:

• 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.

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 body identical 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 find 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 body identical 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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