The Women's Hormone Clinic Logo
The Women's Hormone Clinic Logo

Hormones

Hormones are potent, natural chemical messengers which control every function in your body. Imbalances in your hormones can have an impact on virtually every system, and significantly affect your quality of life.
All hormones are produced from fats, and a diet rich in essential fats is vital for adequate hormone production. The main female hormones are:
Oestrogen
– the major hormone which controls a woman’s journey through puberty, fertility and menopause. Oestrogens regulate body temperature, aid memory function, maintain collagen levels in skin, increase libido, reduce the risk of heart disease, maintain bone density
Progesterone
– an essential balance for oestrogen, present in high levels during pregnancy. It has a naturally calming effect which can enhance mood and improve sleep. As a diuretic it reduces bloating and breast tenderness, stabilises blood sugars, and improves energy and endurance. It also protects against endometrial cancer and fibrocystic breast disease
Testosterone
– although we usually think of it as a male hormone, Testosterone is produced by the ovaries and is essential to female well-being. It acts in women to improve memory, increase motivation, libido, bone density, energy, strength and muscle mass, and promote a sense of well-being
DHEA
– produced by the adrenal glands, it is the hormone present in highest amounts in the human body. Converted into both Oestrogen and Testosterone, normal levels are essential to maintain brain function and memory, support the immune system and promote well-being and motivation
Pregnenolone
– often referred to as the ‘mother hormone’ it sits at the top of the hormone production tree. Low levels are particularly associated with poor memory and word-finding difficulties
Vitamin D
– a steroid hormone which supports strong bones, muscle function and general well-being. Adequate levels are essential to support hormone therapy.

Symptom Checker List

Any of the following can be signs of a hormone imbalance:

Fatigue
Insomnia
Anxiety or irritability
Mood swings
Irregular periods
Hot flushes
Joint pains
Low libido
Bladder problems
Vaginal dryness
Thinning hair
Changing body shape
Memory or concentration problems
Skin complaints
Reduced strength
Breast tenderness
Headaches

%

of women aged 45-65 who have currently experienced the menopause in the past 10 years, had not consulted a heathcare professional about their menopause symptoms.

* May 2016 survey conducted by Ipsos MORI on behalf of the British Menopause Society (BMS) – https://thebms.org.uk

Treatments Offered

Perimenopause

– the time before and after the final period.

Menopause

– the time after a woman has not had a period for at least 12 months.

Premature Ovarian Insufficiency (POI)

– where periods cease before the age of 40.

Pre-Menstrual Syndrome (PMS)

– various menstrual cycle-related symptoms.

Hormonal Acne

– acne experienced during the menstrual cycle.

Osteoporosis

– where bones can become weak or brittle after menopause.

%

of women said their menopause symptoms impacted their social life

* May 2016 survey conducted by Ipsos MORI on behalf of the British Menopause Society (BMS) – https://thebms.org.uk

Hormone Replacement Therapy (HRT)

HRT (Hormone Replacement Therapy) refers to any treatment which involves the taking of hormones to restore the level of those which have fallen in your body. This can be done by mouth, through the skin or vaginally. In menopause care, HRT typically refers to the replacement of falling levels of oestrogen which, for women who have not had a hysterectomy, must be balanced by a progesterone supplement to protect the womb lining.

Oral Oestrogens (taken through the mouth)

  • Estradiol: body identical oestrogen with the same structure as estradiol produced by the human ovary.
  • Conjugated equine oestrogens: synthetic oestrogens.

Oral oestrogens are absorbed through the digestive tract and metabolised in the liver. The by-products of liver metabolism alter our blood clotting and can increase risk of blood clots and stroke. Synthetic oestrogens (may) have added risks and are no longer used as a first choice.

It is best to avoid oral oestrogens in women with risk factors for blood clots of stroke or if they have liver disease or taking liver enzyme inducing medication.

Transdermal Oestrogens (delivered via the skin)

  • Estradiol (body identical)
  • Available in patch, gel or spray

Transdermal estradiol is absorbed directly into the blood stream and has a neutral effect on clotting.

Indications for transdermal therapy:

  • Patient preference
  • Poor symptom control on oral medication
  • Increased risk of blood clots or family history of blood clots
  • Migraine
  • Risk factors for stroke or heart disease such as high blood pressure, diabetes, smoking, obesity, raised cholesterol.

The choice of product usually dependent on your preference according to lifestyle and practicalities of application.

Pros

Cons

Patches

Usually stick well and easy to use.

Steady absorption/constant level.

Easy to travel with.

Twice weekly application.

Worn all the time.

Local skin irritation.

Fall off or crinkle in some women.

Sticky mark can be left on the skin.

Gel

Easy to alter dosage.

Higher dosages need large quantities and lots of plastic bottles.

Requires to be applied daily.

Takes time to absorb before you can get dressed.

Spray

Small volume.

Absorbs quickly.

Requires to be applied daily.

Difficult to know when device is near empty.

Absorption of the different preparations varies from one individual to another and for the same individual, absorption may vary with different preparations, therefore dose adjustments may be needed.

Progestogens:

  • Micronised progesterone: body identical progesterone with the same structure as progesterone produced by human ovaries, derived from yam and plants extract.
  • Synthetic progestogens: norethisterone, medroxyprogesterone acetate, levonogestrel, dydrogesterone.

Progesterone and progestogens are used in an HRT regimen to protect the lining of the womb against the oestrogen. Oestrogen on its own can cause thickening of the lining of the womb and put women at risk of endometrial cancer.

Body identical progesterone can help with sleep and reduce anxiety symptoms. Synthetic progestogens are more effective at controlling bleeding patterns.

For women needing progesterone replacement without oestrogen for PMS/PMDD and early peri-menopausal symptoms body identical progesterone capsules or cream can be used. This is not licensed in the UK but offers many therapeutic benefits. Once a woman needs to add estradiol into her hormone treatment regimen, a licensed progesterone product or progestogen needs to be used to ensure adequate endometrial protection,
f application.

Oral Progestogens (taken through the mouth)

Micronised progesterone is available in capsules. The synthetic progestogens are generally available in tablets.

(Micronized progesterone capsules contain gelatin and therefore not suitable for vegan’s. They also contain soya lecithin and therefore should not be taken by women with a hypersensitivity or allergy to soy or peanuts)

Transdermal Progestogens (delivered via the skin)

There is no transdermal body identical progesterone product that is licensed for endometrial protection as part of an HRT regime.

There are patch regimens that deliver transdermal estradiol and a synthetic progestogen.

Intrauterine Progestogen

Levonogestrel 52mg (Mirena or Levosert) offers endometrial protection, period control and contraception. It has a localised action so can reduce side effects that may be experience with other forms of progesterone.

Systemic side effects are reduced but not completely eliminated.

Vaginal Progestogens

Micronised progesterone can be administered through the vaginal route. This is off license but can be used for women that experience side effects taking the capsules orally.

As with all medications there can be some side effects but these often reduce over time and can be minimised by adjusting the dose or type of HRT.

Topical Vaginal Oestrogens:

This form of HRT can be more effective than tablets, patches or gel for urinary and vaginal symptoms as it targets the tissues directly.

Vaginal oestrogen is available in pessaries, cream or ring depending on patient choice.

They are very safe to use and treatment can be continued long term as required.

Prasterone (Intrarosa):

This is a form of DHEA which is converted to oestrogen and androgens which can be used for vulvo-vaginal atrophy.

Ospemifene (Senshio):

This is an oral tablet for genitourinary symptoms.
It can be considered in women who find vaginal treatments difficult to administer.

Testosterone:

Although testosterone may be thought of as a male hormone, it is also essential for women’s hormonal wellbeing. Testosterone levels fall during as women approach the menopause and testosterone supplementation can be considered in women who complain of low libido. There is lack of evidence to support testosterone supplementation for the purpose of prevention or improving cognitive function, musculoskeletal health, improving energy or improving bone density or fracture prevention. However many women who use testosterone replacement report an increase in energy and improvements in their cognitive function.

There can be some side effects (excess hair growth, acne, hair loss) but these are uncommon if levels are maintained within the female range. It is important that blood levels are checked before starting treatment and then after three months. The monitoring should continue every 6-12 months.

Testosterone products available:

Testosterone replacement is delivered via the skin but there are no licensed testosterone female replacement preparations currently available in the UK. Licensed male testosterone preparations can be used in smaller amounts. These include products such as Tostran and Testogel. Androfeme is a testosterone cream licensed in Australia which is made for women but can only be prescribed in the UK on a private prescription. We can also have a testosterone cream made for you at a specific dose in an easy to use pump pack.

DHEA

DHEA is an androgen produced by our adrenal glands and low levels can be associated with symptoms of fatigue, weight gain, lack of motivation, low mood and low libido.

DHEA is not currently licensed in the UK but is used in Europe for management of menopausal symptoms. It is given in a capsule form and we can prescribe it off license on a if it is indicated and a woman would like to take it.

DHEA blood levels need checking prior to considering treatment and monitored for the duration of therapy.

Pregnenolone:

Pregnenolone is a precursor hormone which is converted into our sex steroid hormones. Low levels can be associated with poor memory and difficulty in word finding. Pregnenolone levels cannot currently be measured unfortunately and treatment is unlicensed in the UK. Pregnenolone can be prescribed on a private prescription for women in whom it is indicated and are comfortable taking unlicensed treatment

HRT Pre-Payment Certificate

This enables women to receive most licensed Oestrogen and Progesterone/Progestogens on an NHS prescription for an annual fee of £19.30 (as of 2023 but likely to change year to year).

During your consultation with our Doctors, we will let you know what products are available on the NHS and what products need a private prescription. For those products that you can receive on the NHS, we will write to your GP and request that they be prescribed for you so that you are able to access the most cost effective hormone treatment available for you.

Symptom checker

Frequently Asked Questions

Is HRT safe?
In the past there have been concerns raised over the safety of HRT and these made big headlines. The main concerns were around the potential increased risks of breast cancer and heart disease and they lead to many women and Doctors being reluctant to use or prescribe HRT. Extensive research has been carried out since and the most recent evidence suggests that while not entirely risk free, the potential benefits of HRT use significantly outweigh the risks for most women. We also now know that the risks are different with different types of hormone and vary with ther route by which they are delivered. We are able to help you weigh up these risks and benefits and make the safest and most effective choice for you.
Are there natural treatments available for menopause symptoms?
Many women would rather try natural or herbal treatments for menopausal symptoms before exploring HRT. There is evidence that for mild symptoms supplements containing red clover and black cohosh can be effective, although not as effective as prescribed HRT. Increasing the amount of soya isoflavones in the diet (which contain plant based oestrogens) is encouraged by many but has not shown any evidence of reduction in hot flushes. St John’s wort can alleviate low mood and anxiety and has some evidence for reducing hot flushes. It is very important to discuss any herbal supplements with your GP before you start taking them as although they are “natural substances” they can interfere with how your body deals with other medications that you are taking.

The talking therapy CBT can not only help with low mood but can also significantly reduced hot flushes and sweats along with improving sleep.

What should I do about contraception in the menopause?
Due to the fact that ovarian function can fluctuate, contraception is needed until you have reached the menopause. That is the point at which you have not had a period for 2 years if you are under the age of 50, or 1 year if you are over 50.
Can my medical history make me unsuitable for hormone treatment?
Some medical conditions such as blood clots or liver disease make certain types of HRT unadvisable but there are safe and effective choices for you. Women who have or have had certain types of cancer including breast cancer are advised to avoid hormonal treatments but there are non-hormonal treatments which can ease your symptoms.
Will HRT give me breast cancer?
This is the risk that women worry most about with HRT. You may have a small increased risk of breast cancer with certain types of HRT (those containing synthetic progesterone) however if you use oestrogen alone because you have had a hysterectomy then the risk can actually be lower. The risk with combined HRT (Oestrogen & Progesterone) seems to depend on which type of progesterone you use and how long you use it for. There are many risk factors for breast cancer and it is important to note that the increase in risk from combined HRT use is less than that caused by drinking a glass of wine each night and significantly less than the increase in risk if you are obese. It is also really important to know that there is no increase in the risk of breast cancer in women using HRT under the age of 51 years.
Do I need to wait for my symptoms to be really bad before I start treatment?
Many women see me and say that they have tried to manage for as long as possible without HRT but things are now unbearable so they have to do something! It is not necessary to suffer with symptoms that are impacting on you quality of life and HRT will help even if you have mild symptoms. In fact there is now increasing evidence to suggest that the earlier you start HRT the more protection it will give you form osteoporosis and heart disease.
I suffer with migraines, can I take HRT?
Although you cannot take the combined oral contraceptive pill when you have migraines the same is not true of HRT. The doses of hormones in HRT are significantly lower than in contraceptive pills as they are aiming to ease your hormonal symptoms and not override the action of your ovaries to prevent pregnancy. It is perfectly safe to use HRT and in fact your migraines may ease however, it is advisable to use HRT that is delivered through the skin as a gel, cream or patch.
When do I have to stop HRT and will my symptoms come back?
Many doctors encourage women to stop their HRT after 5 years but there is no good scientific reason for this. Each woman needs to be assessed according to their symptoms and other risk factors to see how long HRT is needed for and there are no set time scales. Ultimately the length of time you take it for is an individual choice but it is generally advisable to slowly reduce doses as time passes.
What are bioidentical hormones?
Bioidentical hormones are hormones that are identical in structure to those that are naturally produced in your body. Prescriptions can be created specifically tailored to the individual with the use of a compounding pharmacy.

The 2 types of bioidentical hormones:

Regulated bioidentical hormones (Body identical hormones – rBHRT). These hormones are manufactured using set doses and formulations and are available from most pharmacies in the country. They are the preferred choice of HRT by most menopause clinics and are also accessible from your GP.

Compounded bioidentical hormones (cBHRT). These are bespoke preparations which are tailored to an individual’s blood test results and symptoms. Compounded hormones can be combined together into products such as creams, lozenges or capsules making them very flexible and convenient. This form of HRT is unlicensed but is dispensed only y regulated compounding pharmacies.