HRT questionnaire further information
We are carrying out a review of HRT prescribing at Topsham Surgery to ensure that everyone is on the safest and most effective treatment, and some patients will have received a questionnaire via text message to gather further information.
Why have I been sent a questionnaire?
We are carrying out a review of HRT prescribing at Topsham Surgery to ensure that everyone is on the safest and most effective treatment.
This review is particularly important for people who:
- Use oestrogen gels or sprays (where doses may change over time), and/or
- Take GLP/GIP medications (e.g. Ozempic, Wegovy or Mounjaro), which can temporarily affect how some HRT are absorbed
The questionnaire will help us check that you have adequate progesterone protection if needed, and that our records are up to date.
About the Menopause
Menopause is defined as the time when menstruation stops completely because the ovaries stop working. This is diagnosed 12 months after the last natural period. The average age of menopause in the UK is around 51, but this age varies between different ethnic groups.
In the years leading up to the menopause (called the perimenopause) and following their last period, around 80% of patients experience some menopausal symptoms. These may include hot flushes, night sweats, disturbed sleep, low mood, anxiety, chronic tiredness, vaginal dryness, low sex drive, itchy skin, joint aches, headaches, palpitations and many others. For some people symptoms are mild, but for others they can be more severe and affect their quality of life, relationships, family, social, work and sex life. Symptoms can last for months to years, and while the majority will improve, vaginal dryness and urinary symptoms might slowly worsen without treatment.
What is hormone replacement therapy (HRT)?
HRT is a very reliable treatment for moderate or severe menopausal symptoms.
HRT is also recommended to protect the health of patients who enter the menopause early (under the age of 51) even if they do not have symptoms or only minor symptoms.
Taking HRT does not delay the natural end of menopausal symptoms. When started before the age of 60, it is relatively safe for most patients, although the decision to use HRT should always be individual and made with a healthcare professional.
There is no limit set on the duration of use. This will depend on the balance between each person’s individual risks and benefits.
Oestrogen and Progesterone
HRT contains either:
- Oestrogen alone, or
- Oestrogen plus a progestogen (progesterone)
Oestrogen helps bone health and relieves the symptoms of menopause. It is given at the lowest effective dose.
In patients with a womb (uterus), progesterone is needed to protect the lining of the womb from the potentially harmful effects of oestrogen. Without adequate progesterone protection, the womb lining can thicken over time and increase the risk of abnormal bleeding and rarely, womb cancer.
After a total hysterectomy, patients can usually use oestrogen alone unless they have been diagnosed with endometriosis.
Progesterone can be given as:
- Tablets
- Patches
- Hormone-releasing coil (Mirena®, Levosert® or Benilexa®) which lasts for up to 5 years.
Lower-dose coils like Kyleena® or Jaydess® cannot be used as part of HRT as they are not strong enough, but can still be used together with HRT to provide contraception if needed.
It is very important to take both hormones as prescribed and to ensure hormone coils are replaced on time.
What are GLP/GIP medications?
GLP/GIPs include medications such as Mounjaro (tirzepatide), Ozempic or Wegovy (semaglutide) and others. They may be prescribed to treat type two diabetes, or to facilitate weight loss. One of the main ways they work is by slowing stomach emptying. This may reduce the absorption of oral medications.
Alert
Interaction with HRT:
The British Menopause Society has issued guidelines for women on GLP/GIP medications. This applies to both tirzepatide (Mounjaro) and semaglutide (Ozempic, Wegovy).
Oestrogen:
- Transdermal oestrogen (gel, patch or spray) is preferred if you are using a GLP-1 agonist, also, if you are overweight or obese.
- There are no interactions with transdermal HRT.
If you take oestrogen tablets, you may need to switch to a transdermal route.
Progestogen:
- If you take oral progestogen as part of your HRT (e.g. utrogestan, norethisterone, medroxyprogesterone), GLP/GIPs might reduce how well it is absorbed. Progestogen is important to protect your womb lining if you are taking oestrogen.
- Reduced absorption could mean less protection of the womb lining.
What might be recommended:
- Switching to a non-oral form of progestogen (combined patch, hormone-releasing coil) is preferable while the GLP-1 agonist is being used.
- Temporarily increasing the dose of oral progesterone.
After starting or increasing the dose of tirzepatide or semaglutide, you should double your progesterone dose for 4 weeks.
If you do not take your HRT orally (e.g., you use a patch, hormonal coil or vaginal tablet) there are no interactions and you don’t need to worry.
What should I do now?
- Please complete the questionnaire sent to you by the practice.
- Contact the practice to arrange an HRT review if requested following completion of the questionnaire.
- Let us know if you are taking any GLP/GIP medication, including if this is obtained privately.
Further reading:
These information leaflets have been produced by other NHS organisations.
Menopause and HRT: A short guide for women