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Hair-Friendly Hormone Replacement Therapy (HRT) Options


Hair loss is a common concern during menopause, often exacerbated by the decrease in oestrogen levels. Hormone Replacement Therapy (HRT) can help mitigate this issue by replenishing oestrogen, which supports hair growth and prolongs the hair growth cycle. Here, we discuss the most hair-friendly HRT options available in the UK, ranked in order of preference for their benefits to hair health.


1. Estradot Patches


Estradot patches are a popular form of oestrogen-only HRT. They are applied to the skin and provide a steady release of oestrogen, which can help counteract hair thinning and loss by maintaining the hair in its growth phase longer. Patches are often preferred as they avoid the first-pass metabolism in the liver, reducing the risk of blood clots compared to oral tablets.


2. Evorel Patches


Similar to Estradot, Evorel patches are another effective oestrogen-only HRT option. They are convenient to use and have a lower risk of side effects compared to oral HRT. By maintaining estrogen levels, Evorel patches help keep hair follicles in the anagen (growth) phase, thus supporting hair density and reducing shedding.


3. Oestrogel


Oestrogel is a topical gel that provides oestrogen through the skin. It offers flexibility in dosing and is less likely to cause side effects such as blood clots. For women experiencing menopausal hair loss, Oestrogel can help maintain oestrogen levels, thus protecting against hair thinning and breakage.


4. Femoston Tablets


Femoston tablets are a combined HRT that contains both oestrogen and progestogen, suitable for women with an intact uterus. This combination helps to balance hormones and can be particularly beneficial for hair health, as oestrogen supports hair growth and reduces shedding. Femoston is taken daily and can help mitigate other menopausal symptoms as well.


5. Sandrena Gel


Sandrena Gel is another topical option that allows oestrogen to be absorbed through the skin. It is applied daily and can be a good alternative for those who prefer not to use patches or oral tablets. By stabilising oestrogen levels, Sandrena Gel can help maintain healthy hair growth during menopause.


6. Lenzetto Spray


Lenzetto is a transdermal spray that delivers oestrogen through the skin. It is a newer form of HRT and offers the convenience of a quick application. By providing a steady level of oestrogen, Lenzetto can help reduce hair thinning and support the hair growth cycle.


NICE Guidance on HRT


The National Institute for Health and Care Excellence (NICE) provides comprehensive guidelines on the use of HRT for managing menopausal symptoms. Here are some key points from their guidance that are relevant to women considering HRT for hair health:


1. Individualised Treatment: NICE emphasises that the decision to start HRT should be based on an individual assessment of the woman’s health, history, and preferences. This includes considering the type of HRT and the method of administration (patches, gels, tablets, or sprays).


2. Benefits and Risks: NICE highlights the importance of discussing both the benefits and risks of HRT with patients. For many women, the benefits, such as relief from menopausal symptoms and potential improvements in hair health, outweigh the risks.


3. Types of HRT: According to NICE, women with a uterus should take combined HRT (oestrogen and progestogen) to prevent endometrial cancer, while women without a uterus can take oestrogen-only HRT. This is crucial for choosing the right type of HRT to avoid potential complications.


4. Administration Methods: NICE notes that transdermal HRT (patches, gels, and sprays) may have a lower risk of venous thromboembolism (VTE) compared to oral HRT. This makes transdermal options preferable for women at higher risk of blood clots.


5. Monitoring and Review: Regular follow-ups and reviews are recommended to monitor the effectiveness of HRT and to adjust the treatment as necessary. This helps in managing side effects and ensuring the treatment continues to meet the patient's needs.


6. Contraindications and Cautions: NICE advises caution in prescribing HRT to women with a history of hormone-sensitive cancers, unexplained vaginal bleeding, untreated high blood pressure, liver disease, or a high risk of VTE.


Considerations for Choosing HRT


When selecting an HRT, it is crucial to consider personal health conditions, lifestyle, and the specific symptoms being addressed. HRT can come in various forms, including patches, gels, tablets, and sprays, each with its own set of benefits and potential side effects.


Oestrogen-Only HRT: Best for women who have had a hysterectomy, as it avoids the need for progestogen, which is added to prevent endometrial cancer in women with an intact uterus.


Combined HRT: Contains both oestrogen and progestogen and is suitable for women with an intact uterus. This form helps protect against uterine cancer while also addressing menopausal symptoms and hair loss.


Topical Applications: Patches, gels, and sprays are often preferred over oral tablets due to their lower risk of systemic side effects, such as blood clots.


General Tips for Managing Hair Loss During Menopause


1. Healthy Diet: Ensure a balanced diet rich in iron, vitamins, and minerals to support overall hair health.

2. Gentle Hair Care: Use gentle shampoos and conditioners, avoid tight hairstyles, and minimise the use of heat styling tools.

3. Stress Management: Practice stress-reducing techniques such as yoga, meditation, or other relaxation exercises.

4. Consult a Specialist: Seek advice from our trichology prescriber for tailored treatments and to address any underlying health issues contributing to hair loss.


Hormone Replacement Therapy (HRT) can sometimes exacerbate alopecia (hair loss) in women. Specifically, HRT containing the following hormones may be detrimental:


1. Testosterone: Any HRT that includes testosterone or androgenic (male) hormones can potentially worsen hair loss in women. This includes certain formulations used for libido or menopausal symptoms that contain testosterone.


2. Progestins: Some synthetic progestins (a type of progesterone) can have androgenic effects, which may contribute to hair loss.

These include:

  • Norethindrone

  • Levonorgestrel

  • Norgestrel


3. Certain Oestrogens: While oestrogens generally help with hair health, high doses or imbalances can sometimes contribute to hair thinning. For instance, conjugated equine oestrogens (such as Premarin) have been reported to sometimes cause this issue.


For women suffering from alopecia, it is generally advisable to use HRT that is less androgenic or non-androgenic.


This may include:


  • Bioidentical estradiol and progesterone.

  • Non-androgenic progestins like dydrogesterone or micronised progesterone.


It's important for women experiencing alopecia to consult with their healthcare provider to tailor their HRT regimen to minimise the risk of hair loss.


Conclusion


Choosing the right HRT can significantly impact hair health during menopause. Estradot and Evorel patches, Oestrogel, Femoston tablets, Sandrena Gel, and Lenzetto Spray are all excellent options available in the UK that can help manage hair loss by maintaining oestrogen levels. Always consult with a healthcare provider to determine the best HRT option based on individual health needs and preferences.


For further reading and detailed advice, consult resources such as the NHS website https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/

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