The majority of women experience menopause as a period of suffering. They complain about menopausal symptoms such as hot flushes, night sweats, mood swings, migraine, and dryness of the vagina. Another more severe consequence of oestrogen deficiency is osteoporosis. Women are often treated with hormone replacement therapy (HRT).

HRT has been available for more than 50 years. Around 80% of women who take HRT are very satisfied.1 For them, relief of symptoms is the primary motivation to start HRT.

At first sight HRT seems to be complicated. But it is not as difficult to understand as women might think. HRT restores the premenopausal level of oestrogens leading to menopausal symptom relief. It usually consists of a combination of an oestrogen and progestogen. Only when the uterus of a woman has been removed is oestrogen given alone. Women who still have their uterus are advised to take a combination of both hormones because oestrogen stimulates the growth of the uterine lining with the risk of becoming cancerous. Progestogens oppose this unwanted effect on the uterus, and some progestogens even support and enhance the positive effects of oestrogen on symptom relief and bone mineral density.

There are several different preparations of HRT and different administration forms. Oral HRT preparations are the most prescribed form and also the most accepted. They are divided into those taken continuously and those with a drug-free interval.

Sequential combined HRT “imitates” the natural cycle of a woman. While oestrogen is taken on every day of the 28-day treatment, progestogen is only added during the second half. After the final tablet of progestogen, menstruation-like bleeding occurs. For women suffering from cycle irregularities and menopausal symptoms who still want to have a regular bleeding this is the HRT of choice.

Continuous combined HRT with oestrogen and progesterone taken in one tablet throughout the 28-day cycle leads to a complete stop of menstrual bleeding while relieving menopausal symptoms. Whether sequential combined or continuous combined HRT is the best choice depends on the physiological situation and the expectations of the individual woman.

APROM ID# 3079. May 2011.