What Is HRT For Peri-menopause?

Guest Blog by Dr Carys Sonnenberg

What is Hormone Replacement Therapy?

Hormone replacement therapy is a treatment used to help menopause symptoms. It uses one or more of the hormones oestrogen, progesterone and testosterone, and taking HRT has been shown to offer the most effective relief from symptoms of perimenopause and menopause. Many women choose this treatment and benefit from an improved quality of life with a relief of their symptoms and for most women, the benefits outweigh the risks. This article discusses regulated HRT, recommended by the BMS.


The hormones


The type of oestrogen mostly used in regulated HRT is 17 beta-oestradiol. It is derived from the root vegetable, Mexican Wild Yam. This has an identical biological structure to the oestrogen produced in the human ovary and can be given as a gel, a spray or a patch, trans dermally delivered across the skin. It can also be taken orally as a tablet.


All women who still have a womb, and for some after a hysterectomy, who use oestrogen replacement will also need a progestogen. If given alone, oestrogen causes the lining of the womb to thicken, and because of this there is an increased risk of abnormality and endometrial cancer. The progestogen keeps the lining of the womb thin and prevents this from becoming abnormal.  Natural micronized progesterone is called Utrogestan in the UK and is taken orally as a capsule at bedtime. It is also derived from the root vegetable, the yam and is used as part of body Identical, regulated HRT.

Using the Mirena coil is another way of taking progestogen. It releases a progestogen called levonorgestrel into the womb to prevent the lining from thickening and can remain in place for 5 years before it needs to be replaced. It also acts as a contraceptive and can help to reduce heavy periods that are common in the perimenopause. Other synthetic progestogens like Provera or Norethisterone are available in combination patches or tablets.


Some women continue to experience symptoms of low libido, low arousal, and poor sexual satisfaction despite taking HRT with adequate replacement of oestrogen. They may also experience fatigue and brain fog. For these women a trial of testosterone hormone can be beneficial. This can be added to HRT in the form of a 1% or 2% testosterone gel with blood test monitoring, to ensure the levels remain in the female range.


Possible side effects of the hormones in HRT

 When you start taking HRT you may experience some side effects, which for most women, will resolve within 3-6 months. Depending upon which hormones you take, how you take them, and how your body responds to the hormones will influence how you feel. Some women feel wonderful as soon as they start HRT, others find their symptoms improve slowly, and for some women the hormones make them feel unwell and they struggle to tolerate them.



Common side effects associated with oestrogen include breast and nipple tenderness, nausea, headaches, and palpitations. It is sometimes sensible to start slowly at a low dose, and let your body get used to the hormones.

As oestrogen causes thickening of the lining of the womb, the endometrium, it is common to get some unexpected bleeding during the first 3-6 months of taking HRT, whether you are having periods or not. If this continues then it is important to speak with a Dr, as continued unscheduled bleeding can be a sign there is a problem with the womb lining.

Tip: if you are taking patches, see how you feel on day one, two, three and 4 of your patches. Are you getting irritation? Are the patches sticking well? If you are taking gel, are you remembering every day? Are you leaving it long enough to dry?



Common side effects of progestogen are mood changes, which can include anxiety and low mood, problems sleeping, greasy skin or acne, bloating and some gastrointestinal symptoms like  constipation, and diarrhoea. Progesterone and progestogens are different and it’s important to keep a daily diary for a couple of months so see how your symptoms change through the month.

Tip: When are you taking your Utrogestan? Are you taking Utrogestan with food? If you are using Evorel Sequi patches, are you taking them in the right order?



Side effects with testosterone can include weight gain, appetite increase, acne, increased body hair, loss of hair on the head and very rarely deepening of the voice and enlargement of the clitoris. It is common to get some hair growth when you apply the gel.

Tip: Rotate the site to which you apply the gel, so you are less likely to get this hair growth.



Histamine intolerance is not currently a condition recognised by conventional medicine. Oestrogen and histamine are closely related, and it is thought that some women are affected by symptoms caused by the effects of histamine when oestrogen levels are high. This could occur at puberty, at ovulation and at perimenopause as levels of oestrogen fluctuate.

Symptoms of histamine intolerance can be debilitating and widespread. They range from hives, itching, flushing, rhinitis, cough, shortness of breath, acid reflux, nausea, bloating, wind, dizziness, migraine, palpitations, fluid retention, irritability, insomnia, fatigue, tinnitus, joint pains, breast pain, painful and heavy periods. Symptoms can be intermittent, and this condition can be difficult to diagnose.

Tip: There is no test to diagnose histamine intolerance so start with keeping a food diary to identify your triggers and speak with a menopause specialist who has a special interest in histamine.

Hormones affect us all individually and what works well for one woman may not for another. At Rowena Health Dr Carys Sonnenberg takes great care to provide a holistic menopause consultation, concentrating on each symptom in turn, explaining the role of hormones, exploring the unique lifestyle of each patient, helping to support, educate and guide and to develop a shared menopause care plan.

You can book an appointment at Rowena Health for menopause care please visit:


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