Hormone replacement therapy: update and practical prescribing
Peri-menopause and menopause are a normal part of ageing. Nikki Noble gives an overview of hormone replacement therapy and practical prescribing tips
Menopause is a physiological event of ovarian failure due to a loss of ovarian follicular activity. This leads to a lack of oestrogen, resulting in the cessation of menstruation and loss of reproductive function. This article discusses the symptoms of menopause and treatment with hormone replacement therapy. This includes practical prescribing, side effects and long-term benefits and risks. The current shortages of hormone replacement therapy are also addressed. The aim of this article is to enable health professionals to define menopause and gain an understanding of the symptoms associated with it. After reading this article you should be able to: describe when peri-menopause and menopause occur, describe the common symptoms that may be experienced during peri-menopause and menopause, understand of the hormones used in hormone replacement therapy, and understand the practical prescribing of hormone replacement therapy and the benefits, risks, contraindications and side-effects.
Peri-menopause and menopause are not a disease or disorder but a natural change that occurs at midlife, and a normal part of the aging process (Banks, 2019). The average age of menopause in the UK is 51, although symptoms usually start prior to this, around the age of 47-48 (Bagness and Holloway, 2015). This time is called the perimenopause. This is defined as the time when a woman has irregular cycles of ovulation and menstruation leading up to menopause and continuing until 12 months after her final period (National Institute for Health and Care Excellence (NICE), 2015). Menopause is defined as a biological stage in a woman's life that occurs when she stops menstruating and reaches the end of her natural reproductive life (NICE, 2015). Usually, it is defined as having occurred when a woman has not had a period for 12 consecutive months (for women reaching menopause naturally). The changes associated with menopause occur when the ovaries stop maturing eggs and secreting oestrogen and progesterone (NICE, 2015). These definitions are medical in nature and it is important to remember that ‘menopause is a major clinical event that is universally experienced by women, but affects each individual woman uniquely’ (Andany et al, 2016).
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