What to do if you can’t get your HRT meds – and 5 other menopause issues solved

Hormone Replacement Therapy (HRT) is used by around 1 million women in the UK. It boosts hormone levels that wane as women get older and in doing so helps to alleviate symptoms associated with the menopause, like hot flushes and anxiety.

But despite more awareness about HRT thanks in part to celebrities like Davina McCall, many women still have a long list of questions concerning it – including how to get their hands on their HRT medication during the kind of shortages seen in 2022 as GPs struggled to meet the rise in demand, and the most effective alternative natural remedies.

Here, Dr Philippa Kaye, author of The M Word, answers some of the most common HRT queries…

1. How do I get meds if there are shortages?

“The impact of people not having their HRT cannot and should not be underestimated. For many people, it enables them to stay healthy, in themselves and in their relationships, and to remain in work.

“There were stories of people paying extortionate prices at online private pharmacies, buying HRT on the black market, sharing with friends, using out-of-date medications and even travelling to buy HRT abroad. This is clearly far from ideal, or even safe.

“While the government and pharmaceutical suppliers work to resolve the HRT shortage crisis, it may be useful to have some information in case a shortage arises again in the future. The main point is that you do not need to stop your HRT or ration it out in order to make it last longer as there are likely to be prescribable alternatives to the HRT you are already taking. Rules have also been put in place so that pharmacists can substitute prescriptions with a suitable alternative.”

2. Does HRT work straight away?

“That depends. For some women, their sweats or flushes reduce quickly, within a few days, but it often takes three to four weeks, though the maximum effect can take up to three months or so. Other symptoms such as insomnia tend to improve within three months of starting. You may also find that any initial side effects settle down within three months.”

3. Can HRT stop working?

“If you start HRT during the perimenopause or early in the menopause then you are likely to still be producing some oestrogen, so you may only need a low or starting dose of HRT to control your symptoms. Over time it can seem that the HRT stops working and that your symptoms return. But actually it isn’t that the HRT isn’t working, rather that you’re producing less natural oestrogen and therefore need higher doses of HRT in order to replace it and get the symptoms back under control.”

4. How long can you take HRT for?

“There isn’t an arbitrary stopping point or limit to how long you can take HRT for; you don’t have to stop after one, two or ten years! In fact, people can continue to take HRT for as long as they feel it is beneficial or useful for them to do so. Indeed, this is part of the purpose of the annual HRT check, to check that the need for it and its benefits still outweigh the risks.

“While the recommendations are for women to take it for the shortest time required, each woman will have symptoms for differing lengths of time so will need HRT for differing lengths of time, meaning some women will continue taking oestrogen in their 60s, 70s and beyond. The benefits of symptom control and to prevent osteoporosis will continue but the balance of the risks may become greater depending on your history. For vaginal oestrogen, there is no long-term risk, it can be used for long-term maintenance indefinitely, as long as you have active breast cancer.”

5. Can you go ‘cold turkey’ with HRT?

“If you stop suddenly the oestrogen levels will fall rapidly, which can trigger symptoms again. So if you do decide to stop HRT, or it is recommended that you do so, your doctor will generally advise that you gradually decrease the dosage to try to stop symptoms returning.

“Depending on the dosage of oestrogen you are taking, this slow reduction can take a few months. So your doctor may switch from a high-dose oestrogen to a standard dose for two or three months, then to a low dose for another few months, before using oestrogen on alternate days for a period of time before stopping. Decreasing this slowly can help reduce any flushes or other symptoms but that may still occur.

“You may find that your symptoms return after stopping the HRT but they may subside and settle, so you may be advised to wait a few months before deciding whether to remain off HRT or start it again. If you’re struggling with flushes or sweats you may be offered alternatives to HRT.”

6. Why might I be referred to a menopause clinic?

“There are various reasons why your GP may refer you to a specialist menopause clinic, which could either be run by a GP with a special interest (and qualifications) in the menopause or by gynaecologists: if your symptoms are not well controlled; if you have persistent side effects; and if you have an increase in how heavy or the length of your bleeding is, or the bleeding becomes irregular.

“So if it isn’t working, or you aren’t tolerating it, then your GP will refer you to a specialist. However, there are not many specialist menopause services in the country, so you may have to wait, or may be referred to a general gynaecologist in the first instance.”

The M Word: Everything You Need to Know About the Menopause by Dr Philippa Kaye (Vie, £9.99) is out now.


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