HRT is a blessing in disguise in menopausal health. It has and continues to receive negative publicity due to its potential side-effects. The advantages of HRT, if used in a diligent manner, are many. In today’s article, we will discuss the indications, contraindications and types of HRT.


Indications of Hormone

Premature Menopause

Menopause before the age of 40 can be idiopathic, genetic and secondary to medical conditions such as autoimmune disorders, drugs such as chemotherapeutic agents and surgery such as oophorectomy, total or partial. The average age of menopause is 52 years. In addition to investigating the cause for premature menopause, these women should be screened for underlying disorders such as abnormal liver function, abnormal clotting, hypertension and breast disorders prior to treatment.

Bilateral Oophorectomy in Young Patients

If oophorectomy is indicated for benign complicated tumours or lesions suspicious of malignancy, HRT should be initiated post-surgery to avoid the complications that come with a lack of estrogen in later life. The protective effect of estrogen on the heart and bones are vital for women. HRT is initiated and continued till the age of natural menopause.

Menopausal Symptoms

HRT is also frequently prescribed for severe menopausal symptoms such as night sweats and hot flashes. Low mood, irritability, chronic fatigue and lack of energy are extremely troublesome symptoms that are frequently not attributed to menopause and these symptoms can significantly affect the quality of life. Nonhormonal agents are available to treat the same too but are not as effective. HRT is licensed for short-term use in these women (5-10 years).

Also Read: 10 Reasons to Celebrate Menopause

Sexual Dysfunction

A sudden lack of estrogen causes significant deterioration of sexual function. The symptoms range from minimal vaginal dryness to poor libido that affects relationships adversely. A complete psychosexual evaluation is necessary and if the underlying cause is a lack of hormones, this can be easily replaced with good effect with HRT. Frequently in this situation, testosterone or tibolone is used either alone or in combination with other hormones.


The absolute contraindications are estrogen-dependent tumours such as ovarian or breast cancers. Abnormal liver or renal functions, current DVT, recent stroke and coronary artery disease and uncontrolled hypertension are relative contraindications. Thorough initial screenings to rule out these conditions as well as periodic check-ups to confirm good general health, annual mammograms and ultrasound of the pelvis to monitor the pelvic organs are mandatory. Patients should also be counselled in detail about possible red flag symptoms and side effects.

Types of HRT

Estrogen Only HRT

This is indicated in women who do not have a uterus. Frequently, they are used as vaginal creams for atrophic vaginitis in women of all ages, including those with a uterus without any adverse effects.

Estrogen is available as tablets, patches and creams.

Estrogen and Progesterone

This is given as a combination tablet or a sequential tablet with only 10-14 days of progesterone. It is ideally prescribed for women with a uterus and the progesterone component works to avoid endometrial hyperplasia.

Frequently and where indicated, a progesterone-releasing coil is inserted into the uterus and estrogen alone is taken orally or as a patch. This is particularly helpful for premenopausal women with abnormal uterine bleeding.


Tibolone is a tablet that has estrogenic, progesterone and androgen effect. It is particularly helpful in women with significant issues with libido.

In conclusion, HRT is a boon for menopausal women with a sudden lack of hormones. It should always be used with the guidance of your gynaecologist and regular check-ups are a must. The duration of HRT will depend on your condition and is a collective decision between the patient and the doctor. Termination of treatment should never be done without medical supervision. When used at the right time and for the right duration it benefits women and has a significant impact on their postmenopausal health.


Dr. Vaishnavi V L, MD MRCOG CCT (UK)
Consultant Gynaecologist
Kauvery Hospital Chennai