The Pros and Cons of Tablet Hormone Replacement Therapy

Oestrogen
HRT is most commonly prescribed in tablet form. If you have had a hysterectomy, only oestrogen treatment is necessary and should be taken every day, without a break, at about the same time. There are many different brands of oestrogen tablets available on prescription containing varying types of oestrogen. Some are fixed-dose regimens, others try to mimic the menstrual cycle by changing the dose over each 28-day course.

Progestogen

If you have not had a hysterectomy, you need to take a course of progestogen tablets, every month for about 10 to 14 days. They are available in calendar packs combined with the oestrogen tablets so you do not have to work out when to take them. They are also packaged separately so that they can be taken with the woman’s own choice of oes­trogen. If used in this way, one simple regimen that many doctors recommend is to take the proges­togens for the first 10 to 14 days of each calendar month, i.e. starting the 1st of March, 1st of April, etc. This has the advantage that you can adjust the type and dose of oestro­gen and progestogen more easily. As your ‘period’ should start around the middle of the month, your doctor will easily be able to tell if you have any irregular bleeding that may need further investigation. Women whose last natural period was more than one year ago can take progestogens continuously, every day, with oestrogen as a ‘no bleed’ regimen.

- Advantages of tablets: Tablets are easy to take and their effects are quickly reversed if you decide to discontinue treatment.

- Disadvantages of tablets: It is not always easy to remember to take tablets every day, and even more difficult to remember them when away from home. Forgotten tablets can trigger fluctuations in hormone levels and irregular bleeding. The higher doses of hormones, necessary to account for huge losses in the passage through the gut and lever, can increase side effects. Nausea is a more common side effect of tablets than other routes but can be minimized by taking the tablet with food or at bedtime. Rarely, oral oestrogens are so poorly absorbed that menopausal symptoms are not controlled and an alternative type of HRT is recommended.