Menopause can be a difficult time for many women, with symptoms such as hot flushes, vaginal dryness, bone loss and low oestrogen levels affecting daily life. Hormone replacement therapy (HRT) is one treatment option to alleviate these symptoms. However, hormone replacement therapy is highly controversial, as some women find it helpful, while for others it comes with risks. Here's what you need to know about hormone replacement therapy to help you decide if it's right for you.

What is hormone replacement therapy (HRT)?

Hormone replacement therapy replaces the hormones that your body no longer produces during menopause. It can be used to treat a range of symptoms such as hot flushes, vaginal dryness and bone loss. The type of hormone therapy, the dose and the risks depend on individual needs and preferences.

There are different types of hormone replacement therapy:

• Oestrogen tablets
• Oestrogen plaster to stick to the skin
• Oestrogen cream that is inserted into the vagina or applied locally in the vagina

Women with a uterus receive a combination therapy. Women who have not had their uterus removed are also given progestogens, a type of synthetic progesterone. This helps to reduce the risk of uterine cancer.

HRT treatments are generally divided into two categories:

1. Systemic hormone therapy: Systemic hormone therapy is usually administered in the form of tablets, patches or creams. They contain higher doses of oestrogens, which are absorbed by the body and treat common menopausal symptoms.
2. Low-dose vaginal products: Low-dose vaginal products are used to treat vaginal and urinary complaints during menopause. They are usually available in the form of creams, tablets or rings and only contain the minimum amount of oestrogen required.

What are the benefits and risks involved?

The benefits and risks of hormone replacement therapy have been extensively studied and discussed. Short-term treatment can alleviate menopausal symptoms and osteoporosis and reduce the risk of bowel cancer. Hormone replacement therapy can be useful if:

• you have moderate to severe hot flushes or other menopausal symptoms.
• you have had your ovaries removed.
• you were diagnosed with an "early menopause" before the age of 40.
• you cannot treat your osteoporosis in any other way.

However, there are some risks associated with hormone replacement therapy that you should be aware of. These include:

• Increased risk of uterine cancer in women who only take oestrogen (no progestogen).
• Increased risk of breast cancer with long-term hormone therapy.
• Increased risk of heart disease, heart attack, blood clots and stroke.

Women who smoke have a higher risk of complications associated with hormone replacement therapy. Women who start hormone replacement therapy when they are over 60 are also at risk, as are women who have not had menopausal symptoms for 10 or more years. They too can benefit from hormone replacement therapy, but the risks usually outweigh the benefits.

There are various health conditions that can increase the risk of complications with hormone therapy. Talk to your doctor about whether you have any hereditary health risks. These include

• Earlier heart attack or stroke
• Risk of blood clots and vascular disease
• Breast cancer
• Disease of the gallbladder
• Active liver disease
• Cervical cancer

How can I reduce the risk?

There is no "one-size-fits-all" plan for hormone therapy. Your hormone therapy will be tailored to you, your health and your lifestyle. Talk to your doctor about the following topics if you are considering hormone therapy:

• Find out which form of hormone therapy (pill, patch, cream, etc.) is best for you.
• Take the lowest dose of hormone replacement therapy you need for the shortest time you can.
• Go for regular check-ups to make sure your treatment is still working.
• Lead a healthy lifestyle with sport, a healthy diet, no smoking, little alcohol and stress management.

What is the risk of breast cancer?

One of the biggest risks of hormone replacement therapy is breast cancer. Although the risk is relatively low, long-term use of hormone replacement therapy is associated with an increased risk of breast cancer. However, the risk of developing breast cancer from hormone replacement therapy is much lower than the risk of developing breast cancer due to other factors such as age, obesity, alcohol consumption and genetic factors.

Women who have a family history of breast cancer or who already have breast cancer should talk to their doctor about the possible risks and benefits of hormone replacement therapy. In some cases, hormone replacement therapy may not be recommended, or other precautions may be taken, such as regular breast examinations and mammograms.

Do alternative treatment methods also help?

It is important that you talk to your doctor about any alternative treatments you are considering, as some alternative treatments may interact with other medications you are taking or may not be safe in your individual case.

Apart from the severe symptoms, some menopausal symptoms can be alleviated by lifestyle changes or alternative medication.

• Consume enough calcium and vitamin D to support the health of your bones.
• Exercise for your general health and for your bones.
• Use a water-based lubricant or a vaginal cream containing oestrogen to relieve the discomfort.
• Write down when your hot flushes occur so that you can find out what triggers them.
• Sleep in a cool room with breathable bedding and clothing.
• Have a cold drink ready if a hot flush occurs.
• Hot flushes can be treated with medication such as certain antidepressants.

These are just some of the many alternative treatments you can consider.

So what is the bottom line?

In summary, hormone replacement therapy can be an effective treatment for some women with menopausal symptoms, but it is not suitable for everyone. It is important that you talk to your doctor about the potential benefits and risks of hormone replacement therapy and consider alternative treatment options if hormone replacement therapy is not an option for you. Don't forget to maintain a healthy lifestyle, e.g. exercise and a balanced diet, to help manage your menopausal symptoms.