Q. Are there risk factors associated with HRT and Ischemic Heart Disease?

If a woman has Ischemic Heart Disease, oral HRT would not be recommended as a treatment. If she has moderate-severe menopausal symptoms, non-oral HRT can be considered in consultation with the woman and her cardiologist.

Q. How do you know when you need hormone replacement therapy/medication?

Hormone replacement therapy is only required if you have menopausal symptoms interfering with your life.

Q. Why don't you support compounding? Anything that may help women (unless it’s dangerous) should be looked at favourably don't you think?

No, as the medications are not studied for safety and efficacy. For more information, see www.managingmenopause.org.au/management/other-therapies/bioidentical-hormones

Q. Does Livial [tibolone] help sex drive?

Tibolone (sold as Livial) may help sex drive by improving vaginal secretions, increasing free testosterone and mood.

Q. Can a Mirena insertion be used for progesterone in conjunction with the hormone Livial [tibolone]?

It is not necessary as tibolone (sold as Livial) has a progesterone effect as well as oestrogen and testosterone effects.

Q. Is it known that women may cope very well without HRT?

Most women do not need HRT if their symptoms are manageable, or if they have no symptoms at all.

What's DHEA?

DHEA (dehydroepiandrosterone) is a natural body substance. It has not been researched significantly enough to be recommended as a treatment.

Q. If you are on HRT, should you still take calcium supplements?

Yes, if your diet is deficient in calcium. Post-menopausal women are recommended to have 1200-1500mg of dietary calcium each day (three glasses of milk or equivalent). Women who have difficulty consuming this amount should consider a calcium supplement at night.

Q. What is the maximum recommended safe time to stay on HRT for hot flushes etc?

For the treatment of symptoms, women can stay on HRT for up to five years. After five years, the need to continue should be reviewed annually and the reason for taking HRT reassessed e.g. severe symptoms.  In 10 per cent of women, menopausal symptoms may continue for longer than 10 years and these women may require HRT for symptom control for longer periods. Current guidelines recommend that women who take HRT for menopausal symptoms take the lowest effective dose for the shortest time period to alleviate symptoms.

Q. A doctor recommended the use of a Nuva ring as a relief from perimenopause. Please tell me more. I have heard of break through bleeding issues, lubrication issues etc.

The Nuva ring is a new and effective contraceptive vaginal ring and is a very appropriate therapy in the perimenopause.

Q. In what percentage of women is hormone replacement therapy ineffective?

In those where symptoms are not due to menopause.

Q. If I am unable to use oestrogen during menopause due to uterus problems, would I be able to use oestrogen creams for vaginal dryness?

Yes.

Q. If not having symptoms, should you still take hormone replacements?

No. The only possible reason is if you are at significantly increased risk of osteoporosis and are less than 60 years of age.

Q. When is the best time to stop HRT and how do you know when to stop?
Q. What is the best way to stop using HRT patches which I have been using for nearly 5 years? I am 51 years old.

There is no 'best time’, and there seems to be no ‘best way’, whether stopping it suddenly or reducing the dose. Reducing the dose in consultation with your doctor will allow you to see if symptoms return (unless there is a good health reason for stopping suddenly on your doctor’s advice). Hot flushes often return after stopping HRT, sometimes immediately or within the first few months.

Q. What is recommended for hot flushes [therapy] for women who have had an oophorectomy and because of breast cancer are on oestrogen inhibiting medication?  Is there a specific [therapy] for their flushes?

Try venlafaxine (sold as Effexor or Efexor), an SSRI antidepressant that has been shown to reduce flushes in some women. Otherwise Black Cohosh, Clonidine and Gabapentin are all used.

Q. Can you explain exactly what hormone therapy is?

Hormone therapy is used to restore the important female hormones that the ovaries stop producing after menopause. Oestrogen is the main hormone prescribed to relieve menopausal symptoms. If a woman still has her uterus she also needs progesterone to protect the uterus lining from over-stimulation by oestrogen, which in the long-term may lead to uterine cancer. Women who have had a hysterectomy do not need progesterone.

Women experiencing loss of libido (sex drive), lack of energy and ongoing fatigue, even when taking oestrogen therapy, sometimes benefit from low-dose testosterone replacement. However, it is important to discuss psychological and relationship issues with the individual woman as well.

Q. What are the common side effects of taking hormone replacement therapy?

The most common side effects from oestrogen therapy are breast soreness and nausea. These symptoms generally improve over time or by altering the dose or treatment method. Progesterone may cause side effects including bloating, depression and mood swings, similar to symptoms of premenstrual syndrome (PMS). 

Q. How long is it safe to use hormone replacement therapy?

Current guidelines recommend that women who take hormone replacement therapy for menopausal symptoms take the lowest effective dose for the shortest time period to alleviate symptoms.

Q. If I stop taking hormone replacement therapy do the associated risks continue?

If you stop hormone replacement therapy your risks will lessen over time however your risks of osteoporosis will increase with age. Discuss your decision about taking hormone replacement therapy regularly with your health practitioner or whenever you have any concerns.

Q. Will my symptoms return if I stop hormone replacement therapy?

Approximately twenty five per cent of women still experience menopausal symptoms for more than five years and 10 per cent may experience symptoms for longer than 10 years.

Q. Does tibolone (Livial) help with symptoms such as being irritable, insomnia, dry skin, sore joints or only with hot flushes?

Tibolone (sold as Livial) may help to improve mood, help you sleep better, decrease hot flushes and improve general wellbeing. Although a synthetic hormone it actions are similar to oestrogen, progesterone and testosterone.

Content updated 26 August 2011