Practical prescribing of HRT

Oestrogen is a highly effective treatment for menopausal symptoms. Although recent clinical trials do not support use of HRT for long-term protection against chronic disease, many women with unpleasant vasomotor symptoms elect to take HRT for symptom relief. Women who still have a uterus should be prescribed estrogen in combination with some form of progestogen. There are various delivery systems for HRT, though most women in the UK take it in tablet form. ‘No-period’ HRT formulations exist for women who are at least 1 year since their last natural period, though erratic bleeding may occur in the first few months of use. Blood pressure should be checked before prescribing HRT, but no other investigation is mandatory. Cervical screening and mammography should be performed according to national screening guidelines. Women with abnormal bleeding patterns on HRT that persist for more than 3 months should be gynaecologically investigated. There is no upper age limit for prescribing HRT, but it is often tolerated poorly when started in older women. HRT is not a method of contraception, and women who start HRT who are not yet truly postmenopausal should be advised to continue with a standard contraceptive method. There is no fixed duration of time for taking HRT, and women should be managed as individuals. Most women take it for about 2–5 years. Vasomotor symptoms often recur on discontinuation of HRT; if they are severe, women may need to consider taking HRT again.