Combined hrt. Side effects and safety info.
What you need to know.
Helpful info to help you understand when combined HRT may not be suitable, and some of the adverse effects associated with taking it.
What you need to know.
Helpful info to help you understand when combined HRT may not be suitable, and some of the adverse effects associated with taking it.
Combined HRT is made up of two hormones: oestrogen and progesterone (or progestin). The oestrogen can help to tackle menopausal symptoms, like hot flushes, vaginal dryness and night sweats. On its own though, the hormone may also cause the womb to continue to grow (if you still have your womb) and this can lead to endometrial cancer.
The progesterone in combined HRT helps to manage the impact of oestrogen on the womb lining, and so restricts your cancer risk.
Combined HRT products can produce side effects however, and aren’t always suitable for everyone.
Certain side effects are fairly common with combined HRT, but they tend to ease given time, so it’s worth giving a treatment at least 3 months if you can.
If you experience any severe side effects though, or if they persist for longer than 3 months, let our clinician know.
Usually your prescriber will start you on the lowest dose of hormones, and any adjustments can then be made depending on how your body responds.
If you experience any of the following, you should go to hospital or see a doctor immediately.
The side effects below are either very common (occur in more than 1 in 10 women) or common (may occur in up to 1 in 10 women).
The following side effects may affect up to 1 in 10 women:
Uncommon side effects (may affect up to 1 in 100 women) include:
The following side effects are considered to be rare, and may affect up to 1 in 1,000 women:
Further side effects for which the frequency is not known may include:
The risk of developing breast cancer is thought to increase slightly amongst women using combined HRT compared to women who aren’t using it. For every 1,000 women not using combined HRT from the age of menopause up to 69 years of age, 13 may develop breast cancer. For every 1,000 women using HRT for 5 years in this same bracket, a further 10 women may develop breast cancer.
It’s believed that there is a slightly increased risk of ovarian cancer amongst women using combined HRT too. For every 1,000 women using combined HRT over a 5 year period, there may be 1 further incidence of ovarian cancer.
HRT tablets are also linked with a slightly higher likelihood of developing a blood clot. HRT in tablet form may produce 9 additional cases of venous thromboembolism for every 10,000 women each year.
There’s also a small increase in your risk of developing a stroke if you use HRT. From the age of menopause up to 69 years of age, 4 women in every 1,000 may have a stroke. In this same bracket, for women who use HRT for 5 years, there may be 1 extra case of stroke.
Topical HRT treatments like HRT patches contain the same hormones as oral HRT products, so a lot of the side effects are likely to be similar, although they may vary in frequency.
There are some additional side effects that you may experience with topical HRT, however.
There is no evidence of any increased breast cancer risk with topical HRT that is applied directly into the vagina. All other forms of HRT increase your risk of breast cancer slightly.
For more information on side effects of topical combined HRT products, check the patient information leaflet that comes with your treatment.
Combined continuous oral and combined sequential oral HRT products aren’t suitable for all women.
You should not use them if:
It’s very important to let your clinician know what your medical history is during your consultation. Certain types of HRT and products may not be suitable for you if you have a medical condition.
If you experience any of the following, you should inform your prescriber before taking any combined oral or sequential HRT treatments.
Combined topical and combined sequential HRT treatments are made up of the same hormones as combined oral HRT products, so if combined oral HRT options are unsuitable for you due to a health condition, it’s likely that combined topical HRT products won’t be suitable for you either.
There are some additional conditions which make combined topical treatments unsuitable for you, however. Combined topical HRT is not suitable for you if:
Certain medications can interact with combined oral HRT treatments, and make them less effective. These interactions can cause irregular bleeding, and may increase your risk of developing side effects. As such, it’s very important that you let your clinician know if you have recently taken or are currently taking any other medication, or if you’ve been advised to start taking any other medication.
If you’re getting treatment from a care provider who isn’t the prescriber providing you with combined oral HRT, it’s very important to let them know about the HRT you’re taking too (in case this impacts on your treatment).
It’s particularly important to let your prescriber know if you are taking:
Combined topical HRT treatments contain the same hormones as combined oral HRT products, and can cause interactions with many of the same medicines. There are a few additional medicines that combined topical HRT treatments can interact with however.
In addition to the medicines listed above for combined oral HRT products, it’s very important that you inform your prescriber if you are taking:
Before you start your EveAdam consultation, you’ll be asked to provide details of any medications you are currently using in your medical profile. It’s very important to list all of these before getting your treatment plan underway, and to ensure that you keep this updated once your plan has begun, so that our clinicians can make sure that the HRT treatment you’re using is safe for you.
NHS. 2019. Side effects Hormone replacement therapy (HRT). Available at: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/side-effects/ [Accessed 4 February 2021].
Patient. 2019. Oestrogen and progestogen for HRT. Available at: https://patient.info/medicine/oestrogen-and-progestogen-for-hrt#nav-4 [Accessed 4 February 2021].
MHRA. 2019. Table 1: Summary of HRT risks and benefits during current use and current use plus post-treatment from age of menopause up to age 69 years, per 1000 women with 5 years or 10 years use of HRT. Available at: https://assets.publishing.service.gov.uk/media/5d680409e5274a1711fbe65a/Table1.pdf [Accessed 4 February 2021].
EMC. 2020. Package Leaflet: Information for the user. Indivina 1mg/2.5mg tablets, Indivina 1mg/5mg tablets, Indivina 2mg/5mg tablets. Available at: https://www.medicines.org.uk/emc/files/pil.4067.pdf [Accessed 4 February 2021].
EMC. 2020. Package Leaflet: Information for the user. Elleste Duet 1 mg Tablets 1 mg + 1 mg/1 mg film-coated tablets, Elleste Duet 2 mg Tablets 2 mg + 2 mg/1 mg film-coated tablets. Available at: https://www.medicines.org.uk/emc/files/pil.9510.pdf [Accessed 4 February 2021].
EMC. 2020. Package Leaflet: Information for the user. Evorel Sequi. Available at: https://www.medicines.org.uk/emc/files/pil.10930.pdf [Accessed 4 February 2021].
EMC. 2020. Package Leaflet. Information for the user. Evorel Conti. Available at: https://www.medicines.org.uk/emc/files/pil.10929.pdf [Accessed 4 February 2021].
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