Hormone replacement therapy (HRT)
Hormone replacement in premature ovarian insufficiency and surgical menopause: what it is, why it matters and how it's monitored.
What hormone replacement therapy is
Hormone replacement therapy replaces the hormones the ovary has stopped producing before the age it normally would: because of premature ovarian insufficiency, because the ovaries have been removed, or after some medical treatments.
Unlike treatment for natural menopause, here we're not just talking about relieving symptoms: we're talking about replacing what you should have at your age, because a prolonged lack affects bone, the cardiovascular system and overall wellbeing.
When it's indicated
- Premature ovarian insufficiency, before the age of 40.
- Surgical menopause from the removal of both ovaries.
- Other situations of hormone deficiency, assessed individually.
In these cases, unless contraindicated, the usual recommendation is to continue replacement at least until the natural age of menopause, with regular reviews.
How it's done
Like any hormone treatment: a full assessment before starting, choosing the route and dose that suit you best, and follow-up to adjust it. If you want to get pregnant, treatment is coordinated with the fertility workup.
If what you're looking for is treating menopause symptoms at their natural age, what applies to you is menopause hormone therapy.
Frequently asked questions
How does hormone replacement therapy differ from menopause hormone therapy?
The drug may be similar; what changes is the aim and the age. With replacement therapy a hormone that is missing prematurely is replaced — for example, in premature ovarian insufficiency — and that is why the general recommendation is to continue it until the natural age of menopause: it is not over-medicating, it is giving back what is missing.
What side effects does hormone replacement therapy have?
The most common ones at the start are breast tenderness, bloating, nausea or irregular bleeding, which usually settle once the regimen is adjusted. The relevant risks —thromboembolism and, depending on the type and duration, breast— depend on the route, the preparation and your own profile, and that is precisely what is assessed before prescribing it.
What are the drawbacks of hormone replacement therapy?
That it is not for everyone, that it requires follow-up and adjustment, and that it is not indicated with certain personal medical histories. Nor is it a lifelong treatment: it is reassessed periodically. In exchange, it is the most effective option for hot flushes and it protects bone when properly indicated.