References

Abernethy K. Making sense of hormone replacement therapy. Nurse Prescribing.. 2015; 13:(9)452-456 https://doi.org/10.12968/npre.2015.13.9.452

Andany N, Loutfy M, Kennedy VL, Aden M. Perspectives on menopause and women with HIV. International Journal of Women's Health.. 2016; 8:1-22 https://doi.org/10.2147/ijwh.s62615

Bagness C, Holloway D. Managing the menopause at work. Practice Nursing.. 2015; 26:(11)538-541 https://doi.org/10.12968/pnur.2015.26.11.538

Banks S. Menopause and the NHS: caring for and retaining the older workforce. British Journal of Nursing.. 2019; 28:(16)1086-1090 https://doi.org/10.12968/bjon.2019.28.16.1086

Bibas M, Biava G, Antinori A. HIV-Associated Venous Thromboembolism. Mediterranean Journal of Hematology and Infectious Diseases.. 2011; 3:(1) https://doi.org/10.4084/mjhid.2011.030

BMS. Understanding the risks of breast cancer. 2015. https://thebms.org.uk/wp-content/uploads/2016/04/WHC-UnderstandingRisksofBreastCancer-MARCH2017.pdf (accessed 20 January 2019)

BMS. HRT – Practical prescribing. 2018. https://thebms.org.uk/wp-content/uploads/2019/02/03-BMS-TfC-HRT-Practical-Prescribing-02A.pdf (accessed 25 November 2019)

BMS. News: HRT supply issues. 2019a. https://thebms.org.uk/2019/05/hrt-supply-issues/ (accessed 25 December 2019)

BMS. British Menopause Society further update on HRT supply shortages (26 November 2019). 2019b. https://thebms.org.uk/2019/08/british-menopause-society-update-on-hrt-supply-shortages/ (accessed 25 December 2019)

BMS. British Menopause Society further update on HRT supply shortages (26 November 2019). 2019C. https://thebms.org.uk/2019/11/british-menopause-society-further-update-on-hrt-supply-shortages-26-november-2019/ (accessed 9 December 2019)

Canonico M, Plu-Bureau G, Lowe GDO, Scarabin P-Y. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ.. 2008; 336:(7655)1227-1231 https://doi.org/10.1136/bmj.39555.441944.be

Davis SR, Baber R, Panay N Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology & Metabolism.. 2019; 104:(10)4660-4666 https://doi.org/10.1210/jc.2019-01603

Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Research and Treatment.. 2007; 107:(1)103-111 https://doi.org/10.1007/s10549-007-9523-x

FSRH. FSRH Clinical Guideline: Contraception for Women Aged over 40 Years (August 2017, amended September 2019). 2017. https://fsrh.org/standards-and-guidance/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/ (accessed 20 January 2020)

Hamoda H, Panay N, Arya R, Savvas M. The British Menopause Society & Women's Health Concern 2016 recommendations on hormone replacement therapy in menopausal women. Post Reproductive Health.. 2016; 22:(4)165-183 https://doi.org/10.1177/2053369116680501

Hartley. Solving the great HRT mystery. 2019. https://members.tortoisemedia.com/2019/11/28/the-great-hrt-scandal/content (accessed 20 January 2020)

Hillard T, Abernethy K, Hamoda H, Shaw I, Everett M, Ayres J, Currie H. Management of menopause, 6th Edition. BMS2017

Managing women's health in the menopause. 2017. https://www.nursinginpractice.com/managing-women%E2%80%99s-health-menopause (accessed 5 February 2020.)

Islam RM, Bell RJ, Green S, Davis SR. Effects of testosterone therapy for women: a systematic review and meta-analysis protocol. Systematic Reviews.. 2019; 8:(1) https://doi.org/10.1186/s13643-019-0941-8

Jaffe SL. Menopause, cessation of menses, vs. “menopause”, a primary brain disorder?. Advances in Bioscience and Biotechnology.. 2013; 04:(06)15-19 https://doi.org/10.4236/abb.2013.46a003

Janssen-Cilag Ltd. Evorel 50 micrograms per 24 hours Transdermal Patch Summary of Product Characteristics' Electronic Medicines Compendium. 2017. https://www.medicines.org.uk/emc/product/7635 (accessed 20 January 2020)

Jiang Y, Tian W. The effects of progesterones on blood lipids in hormone replacement therapy. Lipids in Health and Disease.. 2017; 16:(1) https://doi.org/10.1186/s12944-017-0612-5

British National Formulary, 74th Ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2017

Loder E. Migraine with aura and increased risk of ischaemic stroke. BMJ.. 2009; 339:(oct27 1)b4380-b4380 https://doi.org/10.1136/bmj.b4380

National Institute of Health and Care. Excellence Menopause: diagnosis and management. 2015. https://www.nice.org.uk/guidance/ng23 (accessed 20 January 2020)

NHS. Causes-Stroke. 2019. https://www.nhs.uk/conditions/stroke/causes/ (accessed 5 December 2020)

Noble N. Symptom management in women undergoing the menopause. Nursing Standard.. 2018; 32:(22)53-63 https://doi.org/10.7748/ns.2018.e11041

Noble N, Holloway D. The Menopause. In: Holloway d. (eds). Cham: Springer; 2019

O'Neill S, Eden J. The pathophysiology of menopausal symptoms. Obstetrics, Gynaecology & Reproductive Medicine.. 2012; 22:(3)63-69 https://doi.org/10.1016/j.ogrm.2011.12.006

Rasmussen L, Dybdal M, Gerstoft J HIV and risk of venous thromboembolism: a Danish nationwide population-based cohort study. HIV Medicine.. 2010; 12:(4)202-210 https://doi.org/10.1111/j.1468-1293.2010.00869.x

Nurse Specialist in menopause.London: RCN; 2017

Roberts H, Hickey M. Managing the menopause: An update. Maturitas.. 2016; 86:(88)53-58 https://doi.org/10.1016/j.maturitas.2016.01.007

Royal College of Obsteticians and Gynaecologists and the British Menopause Society. Joint RCOG & BMS statement in response to the Lancet study on HRT use and breast cancer risk 30 August 2019. 2019. https://thebms.org.uk/2019/08/joint-rcog-bms-statement-in-response-to-the-lancet-study-on-hrt-use-and-breast-cancer-risk/ (accessed 10 January 2020)

Shaw I. Menopause – Guidance on management and prescribing HRT for GP's based on NiCE guidance 2015.: Primary Care Women's Health Forum. Events4healthcare; 2017

How to help patients through the menopause. 2016. http://www.nursinginpractice.com/article/how-help-patients-through-menopause (accessed 20 January 2020)

Stute P, Neulen J, Wildt L. The impact of micronized progesterone on the endometrium: a systematic review. Climacteric.. 2016; 19:(4)316-328 https://doi.org/10.1080/13697137.2016.1187123

Stute P, Wildt L, Neulen J. The impact of micronized progesterone on breast cancer risk: a systematic review. Climacteric.. 2018; 21:(2)111-122 https://doi.org/10.1080/13697137.2017.1421925

Voican A., Francou B., Novac L Pharmacology of Hormone Replacement Therapy in Menopause. In: Gallelli L. (Ed). Rijeka, Croatia: Intech; 2012

Hormone replacement therapy: update and practical prescribing

02 April 2021
Volume 32 · Issue 4

Abstract

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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