The HRT dosage prescribed depends on a number of factors such as its purpose (for example, mainly for symptom control or mainly for reducing the risk of later heart or fracture problems) and a woman’s individual response to it. The oestrogen dosages needed to relieve symptoms may be higher or lower than those required to provide long-term protection against heart disease and osteoporosis, depending on the severity of symptoms. Women on HRT before menopause is confirmed cannot rely on it for contraception as hormone dosages are insufficient to prevent pregnancy. As explained previously, a low-dose combined Pill is one way of obtaining both the benefits of HRT and contraceptive protection.
Whether it is taken every day or for ten to fourteen days per cycle, the total monthly dose of progestogen in HRT is similar to that given to a woman on the Pill. The dosage used by Tessa, who is taking progestogen daily, was arrived at by lowering the daily dose until she had breakthrough bleeding, then adjusting upwards.
Individual variability in the body’s capacity to deal with the hormones of HRT is another reason why a dose that relieves symptoms in one woman has little effect on another. In the case of hormone patches and implants, the position on or in the body affects the amount of hormone the body absorbs and therefore the dosage required.
When a doctor is deciding on the most suitable dosage or hormone format for you, your individual response will be crucial. The hormones used initially may not relieve your symptoms adequately, or they may have unwanted effects. It may then be necessary to change the kind of oestrogen or progestogen used, or to alter the dose.