October is Menopause Awareness Month and with this year’s focus on hormone replacement therapy (HRT), mid-life specialist Jo Ibbott says it’s time to clear up the confusion surrounding this often-misunderstood treatment
What is hormone replacement therapy (HRT)?
HRT combines oestrogen and progesterone. The safest NHS-prescribed HRT is “body-identical”,” using transdermal oestrogen patches, gels or sprays, and micronised progesterone (Utrogestan). Derived from the yam plant, body identical HRT mimics natural hormones. The British Menopause Society says benefits often outweigh risks for suitable women.
Testosterone, which also declines with age, is crucial for many women. Though not widely prescribed in the UK, attitudes are changing. Testosterone replacement can boost energy, cognition, muscle mass and libido.
Answering the BIG question
Many women are put off HRT, wanting to know: does it cause cancer? So where did this come from? In the 1990s, the Women’s Health Initiative (WHI) conducted a clinical trial on HRT in the USA. The results, published in 2002, suggested that long-term use of HRT might increase the risk of breast cancer. Reported more widely in the news media, this caused widespread concern and led to changes in HRT-prescribing guidelines. Many doctors stopped prescribing HRT, and many women stopped taking it. This created a false narrative around HRT, which is still being addressed today.
As Dr Louise Newson explains in her booklet Menopause and HRT: “The negative reports are largely due to a large trial that was reported in 2002 (called the Women’s Health Initiative (WHI) Study) which has since been shown to be flawed. It actually studied women who are older (in their 60s) and they were given types of HRT that we do not prescribe nowadays.”
Women’s Health Concern research on breast cancer risk factors revealed that, out of 1,000 women aged 50-59 in the UK:
- 23 will be diagnosed.
- Combined HRT increases risk by four cases.
- Oestrogen-only HRT reduces risk by four cases.
- Regular exercise (2.5 hours/week) reduces risk by seven cases.
- Being overweight increases risk by 24 cases.
For more details, see their factsheet ‘Understanding the risks of breast cancer’ (details in box below).
The benefits and risks
So, bearing all that in mind, what are the benefits and risks involved in taking HRT?
The benefits
- Management of symptoms
- Improved quality of life
- Reduces the risk of osteoporosis, coronary heart disease and depression.
The risks
- Risks depend on the type of HRT and other factors such as age, weight, alcohol intake and whether you smoke or not. Transdermal, body-identical HRT is considered very low risk.
- Oestrogen in tablet form (older/synthetic type) carries a slightly higher risk of blood clotting.
- Risk of breast cancer is very low and only associated with the combined patch with synthetic progesterone. Drinking two glasses of wine a night or being overweight present a greater risk.
- For most, the benefits far outweigh the risks according to the British Menopause Society.
Does HRT delay menopause?
No. Ovarian function declines as we reach menopause (average age 45-54 years) and symptoms are the result of that. If you’re on HRT and symptoms return when you stop taking it it’s not because you’ve been taking hormones; you would be having the symptoms of menopause anyway.
Talking to your GP
Before I learned about menopause, I believed HRT caused breast cancer. This meant I didn’t even consider it as an option. I had no idea about its long-term health benefits or why it’s so transformative for many women. Finding a fantastic women’s health specialist GP was a turning point in my menopause journey. Thanks to her, I’m now getting the treatment I need and plan to continue HRT for the rest of my life (because I can). Sadly, my experience isn’t the norm, and many women suffer in silence due to a lack of information. This is unacceptable.
Here are some top tips for preparing for and talking to your GP:
Understand the symptoms of peri/menopause.
Understand your symptoms and how they are impacting you.
Ask if your doctor’s surgery has a women’s health specialist GP and ask to see them.
Do some background research around HRT so you have a level of understanding about it. You get ten minutes with your GP; you want to make the best use of your time.
If you have other health issues, a family history of breast cancer or are considered high risk of cancer, discuss with your GP the risks and benefits of HRT for your specific situation.
If you decide with your GP that HRT is right for you, ask when you should notice an improvement in your symptoms and when you should go back for a review.
Put a note in your diary to book that review with your GP. It’s common for symptoms to improve initially then begin to return. You need to talk to your GP about increasing your dose if that’s the case.
HRT might not be the perfect solution for every woman, but it deserves careful consideration. Armed with accurate information, you can have a more meaningful conversation with your doctor about your options. HRT is considered a cornerstone of menopause management by many menopause specialist GPs, not just for relieving symptoms but also for long-term health. Remember, menopause matters and understanding your choices is key to navigating this life stage with confidence.
Helpful resources
balance-menopause.com/menopause-library/menopause-and-hrt-booklet/
balance-menopause.com/menopause-library/body-identical-hormones/
The Definitive Guide to Perimenopause and Menopause by Dr Louise Newson (Hodder & Stoughton)
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