Hormones for menopause: treatment choices

Menopausal hormone therapy replaces hormones to reduce symptoms caused by changing ovarian hormone levels. Oestrogen may be given through the skin, by mouth or locally in the vagina, depending on the problem being treated. If you have a uterus, a progestogen is generally considered with systemic oestrogen to protect its lining. Local vaginal treatment works mainly in nearby tissues and is discussed differently from treatment for flushes. The choice also depends on past blood clots, certain cancers, liver problems, migraines, bleeding and other health factors.

Write down your main symptoms, when they began, your last menstrual bleeding and any medicines or supplements. Tell the clinician about previous clots, unexplained bleeding, breast or womb conditions, migraines and liver disease. Ask about the intended route, expected benefits, possible unwanted effects and when to review the plan. Use the prescribed product exactly as directed; avoid borrowing hormones or changing the schedule without advice.

Get medical advice for bleeding after menopause or bleeding that is unexpected while using hormones. Seek urgent help for chest pain, sudden breathlessness, coughing blood, a painful swollen leg, severe headache, fainting or new weakness. Contact your clinician promptly if treatment causes troublesome symptoms, an allergic reaction or persistent pelvic pain.

What symptom are we treating, and how will we know whether it is improving? Do I need a progestogen with oestrogen? Which route suits my health history? How should unexpected bleeding be handled?