Hormone Replacement Therapy (HRT) can feel overwhelming. Whether you're considering it, using it, or just curious, it’s natural to have questions.

One key area HRT impacts is pelvic health, from incontinence to bladder function. Keep reading as we break down what HRT is, it's risks and benefits, as well as how it can impact pelvic health.

What Is Hormone Replacement Therapy (HRT)?

Let’s start with the basics. HRT is a treatment designed to replace hormones that naturally decrease during menopause. It usually involves oestrogen or a combination of oestrogen and progesterone.

There are two main types: systemic HRT, which works throughout the whole body to address broader symptoms like hot flushes, and local HRT, which targets specific areas like the vaginal or pelvic region to help with issues such as dryness or bladder control.

Many turn to HRT to ease symptoms, and it’s also becoming an important focus in the world of pelvic health.

How Hormones Affect Your Pelvic Health

Think of your pelvic area as a team, and hormones are the coach. They keep everything—your bladder, muscles, and tissues—working together smoothly. When oestrogen levels drop, as they do during menopause, that’s when the team can lose its rhythm.

This can lead to issues like:

• Weakened pelvic muscles
• Increased risk of incontinence
• Vaginal dryness and discomfort

HRT steps in to give your hormones a boost, helping your pelvic team get back in the game. But, like any coach, HRT isn’t perfect, so let’s chat about the pros and cons.

The Benefits of HRT for Pelvic Health

HRT can be a game-changer for pelvic health, offering relief from common menopause-related symptoms.

From improving bladder control to easing vaginal dryness and supporting pelvic muscles, HRT can help you feel more comfortable and confident in your daily life. 

Here’s how:

Improved Bladder Control

Urinary incontinence is a common menopause symptom. Local oestrogen treatment, a form of HRT, involves applying oestrogen directly to the vaginal or pelvic area through creams, rings, or tablets.

Evidence suggests this targeted approach may improve incontinence by strengthening tissues around the bladder and urethra, reducing frequency and urgency.

However, systemic HRT, like conjugated equine oestrogen, may worsen symptoms in some cases. [1]. Choosing the right option is key to managing menopause and incontinence effectively.

Less Vaginal Dryness

Vaginal oestrogen therapy, a localised form of HRT, is effective in restoring natural lubrication, easing discomfort and irritation associated with vaginal dryness [2].

This targeted treatment improves overall vaginal health by addressing symptoms of atrophic vaginitis, a condition common in postmenopausal women due to decreased oestrogen levels [3].

By applying oestrogen directly to the vaginal area through creams, rings, or tablets, it helps maintain the thickness and elasticity of vaginal tissues, reducing dryness and associated discomfort [4]. 

Stronger Pelvic Floor

Reduced oestrogen levels during menopause can weaken pelvic floor muscles, leading to discomfort or prolapse. HRT, particularly oestrogen supplementation, may help maintain muscle tone and support pelvic health.

However, it's important to note that while oestrogen benefits the pelvic floor, it may not directly strengthen the muscles themselves. Studies show that oestrogen helps the pelvic floor not by strengthening the muscles directly but by improving the surrounding tissues and non-muscle components. Research suggests it supports the connective tissue and other layers, leading to improved pelvic floor function and symptom relief [5].

Therefore, combining HRT with pelvic floor exercises may provide the most effective approach to maintaining pelvic health during menopause. 

The Risks of HRT

Of course, no treatment is perfect. HRT does come with its risks, and it’s important to weigh them carefully. Some things to keep in mind:

Certain Health Risks May Vary

HRT might slightly increase the risk of breast cancer, blood clots, or stroke, depending on an individual's unique health history.

Not a One-Size-Fits-All Solution

HRT isn’t right for everyone. If you have a history of certain conditions, like hormone-sensitive cancers, it might not be a safe option.

Side Effects

Like any medication, HRT can cause side effects such as bloating, headaches, or nausea. Most are mild, but it’s worth discussing with your doctor.

Still, for many, the benefits outweigh the risks. The key is finding what works best for you.

What You Need to Know Before Starting HRT

Thinking about giving HRT a go? Here are a few tips to keep in mind:

Chat with Your Doctor

Always a must. They’ll help you weigh the pros and cons based on your unique health history.

Start Small

Many people begin with a low dose to see how their body reacts.

Be Patient

HRT isn’t an overnight fix. It may take a few weeks or months to notice changes.

Remember, you’re the boss of your body. HRT is just one tool in your toolkit.

Alternatives to HRT

Not considering HRT? That’s okay! There are other ways to support your pelvic health:

Pelvic Floor Exercises

These are simple and effective ways to strengthen the muscles that support your bladder, uterus, and rectum. By regularly practising pelvic floor exercises, you can improve muscle tone and reduce the risk of leaks or discomfort over time.

Bladder Training

This involves setting a schedule for bathroom breaks to help control leaks and retrain your bladder. Over time, this method can increase the bladder’s capacity and reduce the urgency or frequency of trips to the bathroom. Effective bladder training methods can provide a simple yet effective way to manage symptoms and improve confidence.

Lifestyle Adjustments

Small changes, like staying hydrated and avoiding bladder irritants (looking at you, caffeine), can make a big difference.

Non-Hormonal Treatments

Options like vaginal moisturisers or laser therapies can also help tackle dryness and discomfort.

Pelvic Health Is for Everyone

Taking care of your pelvic health is essential, whether you choose HRT, pelvic floor exercises, or a mix of both.

It’s about more than just managing leaks or dryness—it’s about feeling confident, comfortable, and free to live life fully.