Synthetic HRT – One size does not fit all

Dr Bram Brons looks into the different hormone replacement therapy’s (HRT) commonly prescribed to women today and explains why one size of synthetic hrt does not fit all.

Starting the menopause can bring a number of challenges. The first of these is deciding whether to begin hormone replacement therapy (HRT) to replace the hormones no longer produced because of the menopause. Although there have been some reported risks with HRT, there have also been notable benefits. Some women are not affected by symptoms of menopause and as such decide against HRT. Other women, due to their medical history, are unable to take therapy treatment. If you decide to take HRT, your doctor will examine you before prescribing therapy treatment. He or she will also ensure you know the risks of HRT. With over 60 different treatments, your doctor will advise you on the best one for you. The three main HRT’s commonly prescribed are:

  • Oestrogen-only
  • Cyclical
  • Continuous combined

There are a number of factors that will determine which HRT your doctor will prescribe to you. In general HRT will usually be prescribed in the lowest dose for the shortest length of time.

Oestrogen-only HRT

Otherwise known as unopposed oestrogen therapy, this type of HRT contains oestrogen only and is usually recommended to women who have had a hysterectomy (removal of the uterus). This is because the exclusion of progestogen has been linked to an increased risk of cancer of the endometrium (cancer of the womb lining). This HRT is taken on a continuous basis with no breaks between packs.

Cyclical HRT

Also known as sequential HRT, this type of HRT is usually prescribed to women who are still experiencing symptoms of the menopause and are still having regular periods. Therapy will usually involve daily oestrogen, with the inclusion of progestogen for 10 – 14 days during the month. Alternatively you may be prescribed a three monthly HRT which will involve taking daily oestrogen with progestogen included every three weeks for 14 days. This form of HRT also mimics your natural cycle so that you will continue to experience frequent bleeds until the menopause causes them to stop.

Continuous combined HRT

This type of HRT is usually prescribed to women who are post-menopausal and have not had a period for more than a year. This HRT involves taking daily oestrogen and progestogen without any breaks. While taking this therapy preparation it is unlikely that you will experience a period.


In contrast to traditional HRT, this synthetic hormone acts like oestrogen, progestogen and testosterone in the body’s tissue all in one dose. This HRT is taken daily and you will not experience a period after menopause. It does, however, have the same related risks as continuous combined HRT. This therapy preparation is not suitable for women who have had a history of heart disease or breast cancer.

HRT side effects

Each hormone replacement therapy is linked with certain side effects, although side effects will usually disappear over time. If side effects persist, however, it is advised that you speak to your doctor by changing the dose or type of HRT.  Common side effects include breast swelling or tenderness, headaches, fluid retention, abdominal bloating, nausea and indigestion.

What to consider

For some women, the symptoms of menopause are not bothersome; therefore therapy treatment is not required. If due to problematic symptoms you wish to take HRT you will need to speak to your doctor, who will be able to inform you fully about the benefits and risks of HRT. From assessing your medical history, he or she will be able to choose the best therapy preparation for you. Finding the right therapy treatment can take some time, so you may need to try a variety of HRT’s before you find the one that is right for you and your body.

To learn about and compare the features associated with HRT treatments visit

Dr Bram Brons is an independent GP and a member of the medical team at HealthExpress – – an online clinic that specialises in a range of health issues, including female sexual health. 

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