HRT and hypermobility
- The HMSA
- Feb 5
- 5 min read
Updated: Feb 17
[This article was written by the HMSA, with advice and guidance from Lexie Minter, BSC Nursing, BSC Midwifery, Nurse Prescriber and Dr Colinette Margerison, GP with a special interest in gynaecology, BMS specialist and trainer, FSRH specialist and trainer.]
Hormone Replacement Therapy (HRT) involves the replacement of one or more of the hormones oestrogen, progesterone, and testosterone.
In some situations, it is appropriate to consider HRT as part of a broader management plan for hypermobile people.
Everyone’s hormone profile is different, and it changes with age. This means it can take time and trial and error to find the right hormone levels for an individual starting HRT. Dosage and the exact combination of hormones needed can also change over time, so prescriptions should be adjusted based on the symptoms experienced.
It is also very important to take into account the potential impact of hormones on symptoms associated with hypermobility when medications containing or affecting these hormones are taken for other reasons – for example as part of birth control, acne management, gender reassignment, or precocious puberty management.
Joint and muscle related
Progesterone tends to increase joint laxity, it should be used with caution in hypermobile people. It’s common for hypermobile people to experience more joint problems when taking progestogen-only preparations (a hormone that mimics the effects of progesterone, such as the mini-pill or coil), but it can still be worth trying as this is not true of everyone. Oestrogen seems to help reduce inflammation and age- related muscle loss. Anecdotally, testosterone has been reported to improve coordination and strength in post-menopausal women, but limited research has been conducted in this area. Therefore, the full effects of testosterone are still unclear, and more research needs to be done
Skin related
HRT can impact collagen production in the skin – improving skin elasticity, hydration, and reducing wrinkles. Oestrogen is also thought to help prevent thinning of the skin.
Bladder related
Oestrogen can help the function of the bladder and urethra reducing symptoms of urgency and frequency of urination and reducing the need to get up at night to pass urine
.
Cardiovascular related
Oestrogen can help to stabilise heart rhythm, and it is possible (although not yet studied) that the improvement in blood vessel function associated with Oestrogen may reduce symptoms of autonomic dysfunction such as postural orthostatic tachycardia syndrome (PoTS).
General wellbeing
HRT overall can help reduce fatigue and improve energy levels.
The effects of HRT are very individual – they are influenced by many other factors, including overall health, genetics, and lifestyle – so this list is of possibilities and things to consider, rather than a definitive list of cause and effect.
Types of Hormones used in HRT
There are many different types of and preparations of HRT, and different things will suit different people.
Oestrogen: - Currently, the most common type of oestrogen prescribed is transdermal oestradiol. This can be in the form of patches, gels, or sprays.
Oral oestrogen used in HRT is also oestradiol. It is currently more common to see this as a second line treatment if there are reasons not to use transdermal oestrogen, because it is metabolised differently and is associated with a slightly raised risk of blood clots.
It comes in different doses, which may need to be adjusted over time.
Progestogen: - This is essential for anyone with a uterus, who is using oestrogen replacement, to prevent thickening of the womb lining. Options include body identical progesterone (Utrogestan), Mirena coil (releases progestogen), or other progestogens in patches or tablets.
Testosterone: Although menopausal women often ask about taking testosterone for other reasons including cognitive function and fatigue, the current research only relates to libido – so a lot more research is needed. Currently no testosterone products are licensed for use in women in the UK, but some healthcare professionals may prescribe them off-label.
Local Vaginal Oestrogen: Used for symptoms such as vaginal dryness, pain during intercourse, and urinary issues. It can be applied as a pessary, cream, gel, or a ring that stays in the vagina for 90 days and can be used at any age.
When to consider HRT
HRT is usually recommended when symptoms negatively impact quality of life. They can be an option at various stages of life, including during the perimenopause, menopause, and post-menopause.
NICE guidelines suggest starting HRT early, preferably before the age of 60 or within 10 years of menopause, without waiting for periods to stop. There is evidence that oestrogen will benefit bone strength after the age of 60, so there is no time limit on starting or duration of use.
Potential Benefits of HRT:
The main potential benefit of HRT in hypermobility is the relief of symptoms associated with hormonal fluctuations, including pain, joint problems, fatigue, brain fog, and bladder issues.
However, it will also reduce the risk of osteoporosis and fractures after menopause, and if started within 10 years of the menopause it may reduce the risk of cardiovascular disease. It is also thought to lower the risk of type 2 diabetes, depression, bowel cancer, and osteoarthritis.
Side effects of HRT:
As with any medication, HRT can cause a range of side effects. Common side effects can include:
Headache
Breast tenderness or pain
Unexpected vaginal bleeding or spotting
Feeling sick (nausea)
Mood changes
Muscle cramps
Diarrhoea
Mild rash or itchy skin
Itching or hives
Serious side effects from continuous combined HRT are rare but can include deep vein thrombosis (DVT) – so any leg swelling or shortness of breath means seeing a health care professional urgently. In addition, anyone who finds lumps or changes in their breasts, or changes in vaginal bleeding while on HRT should speak to their doctor.
Given these side effects, whether someone chooses to take HRT or not needs to take into account whether the overall effect on the individual is positive or negative.
Managing Risks Associated with HRT
It is a common myth that HRT can’t be taken by anyone with a family history of breast cancer, blood clots, migraines, or high blood pressure, or who is too old or too young.
Our understanding has moved on since the early study that raised these as potential issues, and it should be possible for people in all these groups to work with their healthcare provider to try to find the most appropriate form of HRT.
We know, for example, that families who have the BRCA 1 or 2 gene mutation are candidates for HRT once they have had risk reduction surgery. There are many other gene mutations that we are becoming aware of and the risk associated with them needs to be assessed on an individual basis.
In conclusion
The decision to try HRT should be personalised, considering individual medical history, family history, and lifestyle factors, in consultation with an appropriate healthcare professional. There are a variety of HRT options available and healthcare professionals should be able to give advice on the risks and benefits of each and help individuals to find the right starting point.
Depending on how well symptoms are being controlled and the side effects experienced, people may, in consultation with their healthcare professional, decide to change the dosages, change the route they take their HRT, or discontinue it.
HRT can be a source of stability in life while transitioning through the perimenopause but should always be used alongside lifestyle measures such as healthy eating and exercise.
Some Useful links about the risks of HRT:
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