HRT: What We Treat

Menopause

Overview:

Menopause is a natural phase of ageing that usually occurs between 45 and 55 years when periods stop due to declining hormone levels. While every woman experiences menopause, the impact can vary greatly. Common symptoms include hot flushes, night sweats, anxiety, fatigue, weight gain, poor concentration, and bladder issues. For many women, these symptoms can be debilitating.

How We Treat Menopause

• Replace lost hormones with body/bio-identical options to relieve symptoms and support bone, cardiovascular, and brain health.
• Start with readily available medications and transition to alternatives if necessary.
• Assess additional factors such as thyroid function, insulin resistance, lifestyle, nutrition, and supplement needs.

Common Practices

• Reliance on NHS-supplied combinations of oestrogen and progesterone, which some women do not tolerate.
• Use of therapies such as acupuncture, antidepressants, or CBT that may not address the underlying hormone imbalance.

Common Symptoms:

Emotional & Cognitive Changes:

• Persistent feelings of anxiety
• Episodes of depression
• Increased irritability
• Difficulty with memory/brain fog/retention of information

Sleep & Energy Issues:

• Trouble falling or staying asleep
• Chronic fatigue

Temperature & Vascular Fluctuations:

• Sudden, intense heat waves (hot flushes)
• Excessive night sweating

Musculoskeletal & Neurological Discomfort:

• Joint aches and stiffness
• Loss of muscle tone
• Frequent, severe headaches (migraines)

Reproductive & Urinary Concerns:

• Reduced sexual desire
• Discomfort or pain during intercourse
• Vaginal dryness
• Urinary irregularities

Dermatological & Sensory Changes:

• Fragile, thinning skin and hair
• Dry or irritated eyes

Metabolic Changes:

• Unexplained weight gain

Premenstrual Syndrome (PMS)

Overview:

PMS encompasses a range of physical and psychological symptoms that occur in the luteal phase (days 15–28) of the menstrual cycle. It is caused by an imbalance between oestrogen and progesterone.

How We Treat Premenstrual Syndrome (PMS)

• Use body/bio-identical progesterone to balance hormones naturally.
• Support treatment with nutritional guidance, exercise advice, and supplements.

Common Practices

• Prescription of oral contraceptives to “switch off” ovarian function, along with antidepressants and CBT for mood regulation.

Common Symptoms:

Skin & Digestive Issues:

• Persistent acne
• Abdominal bloating
• Breast tenderness

Neurological & Musculoskeletal Discomfort:

• Frequent headaches and migraines
• Joint pain
• Muscle aches

Emotional & Sleep Disturbances:

• Low mood with irritability
• Episodes of tearfulness
• Disrupted, poor-quality sleep

Systemic & Metabolic Signs:

• Chronic fatigue
• Night sweats
• Palpitations
• Intense sugar cravings
• Unexplained weight gain

Adenomyosis & Endometriosis

Overview:

• Endometriosis: Occurs when tissue similar to the uterine lining grows outside the womb (ovaries, fallopian tubes, bowel, bladder, etc.), causing painful periods and potential infertility.
• Adenomyosis: Involves the growth of uterine lining tissue into the muscular wall of the uterus, resulting in painful, heavy periods.

How We Treat Adenomyosis & Endometriosis

• Use body/bio-identical progesterone to counteract excessive oestrogen effects, reducing pain and abnormal bleeding.

Common Practices

• Pain management with anti-inflammatories, combined hormonal therapies (such as the pill or Mirena coil), and surgical options including laparoscopy or hysterectomy in severe cases.

Common Symptoms:

Menstrual & Reproductive Health:

• Painful menstrual periods
• Heavy or irregular bleeding
• Difficulty conceiving (infertility)

Pelvic & Musculoskeletal Discomfort:

• Chronic pelvic pain
• Lower back pain

Systemic Symptoms:

• Persistent fatigue

Fibroids

Overview:

Fibroids are benign uterine growths stimulated by high oestrogen or low progesterone. They can vary in size and may be asymptomatic or cause significant pain and heavy bleeding.

How We Treat Fibroids

• Treat with body/bio-identical progesterone to counteract oestrogen stimulation.
• Use supplements such as DIM to help restore balance and address nutritional deficiencies (e.g., iron loss due to heavy bleeding).
• Reserve surgical intervention for very large fibroids.

Common Practices

• Commonly managed with the oral contraceptive pill, tranexamic acid for heavy bleeding, intrauterine devices (IUDs) releasing progesterone, or in severe cases, surgical options.

Common Symptoms:

Pain & Discomfort:

• Abdominal cramps or pelvic pain
• Persistent lower back pain
• Painful or heavy menstrual periods

Digestive & Bloating Symptoms:

• Abdominal bloating
• Bowel irregularities or disturbances

Reproductive Impact:

• Occasional difficulty conceiving (infertility)

Postnatal Depression (PND)

Overview:

Postnatal depression affects about one in ten women (and can also impact partners) within the first year after childbirth, largely due to extreme hormonal fluctuations.

How We Treat Postnatal Depression (PND)

• Restore hormonal balance using body/bio-identical progesterone.
• Provide referrals for psychological therapies and, if necessary, prescribe antidepressants for severe cases.

Common Practices

• Typically relies on cognitive behavioural therapy and antidepressants without directly addressing hormone deficiencies.

Common Symptoms:

Emotional & Psychological Wellbeing:

• Ongoing anxiety
• Feelings of guilt and low self-worth
• Intrusive or distressing thoughts
• Withdrawal from social interactions
• Difficulty bonding with the baby

Sleep & Energy Levels:

• Disrupted sleep patterns
• Persistent low energy or exhaustion

Thyroid Disorders

Overview:

Thyroid conditions—whether underactive or overactive—affect metabolism and overall energy levels. An underactive thyroid can lead to weight gain, fatigue, and cognitive decline.

How We Treat Thyroid Disorders

• Proactively screen for thyroid dysfunction and treat early with personalised hormone therapy.
• Prescribe T3, which is often not available on the NHS, for better management of underactive thyroids.
• Address contributing lifestyle and nutritional factors.
• For overactive thyroids, we refer patients to their GP or an endocrinologist for specialised care.

Common Practices

• GPs typically use levothyroxine, which may not be effective for every patient.

Common Symptoms:

Emotional & Neurological Symptoms:

• Persistent anxiety
• Irritability or mood changes
• Sleep disturbances
• Hand tremors or shakiness

Temperature & Cardiovascular Responses:

• Sensitivity to heat or cold
• Heart palpitations

Physical Changes:

• Noticeable swelling in the neck (possible thyroid enlargement)
• Unexplained weight loss or gain

Infertility (Hormonal Balance)

Overview:

Infertility may result from hormonal imbalances that disrupt the reproductive process. While most couples conceive within one to two years, some face challenges that warrant early investigation—especially when the woman is over 35.

How We Treat Infertility

• After six months of unsuccessful attempts, we investigate underlying hormonal and metabolic issues in both partners.
• Ensure that reproductive hormones are balanced and address lifestyle factors that may impact fertility.

Common Practices

• Couples are often advised to wait at least a year before undergoing testing, potentially delaying necessary intervention.

Hormonal Hair Loss

Overview:

Hormonal hair loss, which includes thinning and excessive hair growth, can be caused by declining oestrogen levels and an imbalance in androgens. This condition affects both men and women and is often linked to thyroid issues, nutritional deficiencies, or insulin resistance.

How We Treat Hormonal Hair Loss

• Assess hormone levels to identify underlying causes of hair loss.
• Replace missing hormones appropriately using targeted HRT and bespoke medicated hair tonics.
• Address nutritional deficiencies (e.g., iron, vitamin B12) and metabolic issues to support hair regrowth.
• DNA testing to help generate personalised medication to address the individual’s cause of hair loss.

Common Practices

• Many clinics do not investigate the root cause, often leading to treatments that do not address the underlying health issues.

Common Symptoms:

Hair Changes:

• Thinning hair or noticeable hair loss on the scalp
• Excess hair growth on the face or body (hirsutism)
• Loss or thinning of eyebrow hair

Underlying Indicators:

• Additional visible signs of hormonal imbalance, such as oily skin, acne, or irregular periods