One of the things most people associate with menopause is HRT. It’s a very controversial therapy and many women (and GP’s!) have strong opinions on it. Either for or against. However, there are also a ton of women who really don’t know much about it. So what actually is it? Well hopefully after reading this post, you’ll feel a bit more educated about HRT which will help you to decide if it’s something that will help you. This is a very personal decision to make and one that should be made with all the facts.
What is HRT?
HRT stands for hormone replacement therapy. It is essentially a medication that replaces the hormones that are at reduced levels in your body during menopause. This then stops the symptoms for many women.
HRT got a bad reputation in the early 2000s with people believing it increased the chances of breast cancer and blood clots. Since then though, a lot of research has been done and debunked this to a certain degree. The study done by the Women’s Health Initiative that caused the controversy was found to use a poor sample of women who already had a ton of risk factors which made the data inaccurate. Since then, a lot of other research has been done which suggests it is much less risky than first thought.
NICE guidelines now assert that, for the large majority of women under 60, the benefits of HRT outweigh the risks.
Benefits of HRT
For many women, the main symptoms that they get relief from by using HRT include:
- hot flushes
- night sweats
- mood swings
- vaginal dryness
- reduced sex drive
There is also a large body of evidence to prove that HRT can reduce your risk of developing osteoporosis and cardiovascular disease. After menopause, your risk of developing osteoporosis and cardiovascular disease increases due to the reduced levels of oestrogen in your body.
Risks of HRT
Like any medication, there are risks and it’s important you weigh them carefully before making a decision. For some women with particularly bad symptoms, they feel the benefits outweigh the risks and that’s fine. For some, they prefer to manage the symptoms in other ways to reduce the risks. Again, this is a personal decision.
If you have a history of breast cancer or family history, you might be more reluctant to take HRT as perceived increased breast cancer risk seems to be a major barrier for some women to taking HRT. Family history does not rule it out though. Whilst a family history is a strong risk factor for developing breast cancer, overall, most women will not develop breast cancer and those who do will not have familial breast cancer.
For women who have been identified as having the BRCA 1 or 2 gene mutation. if you have had a bilateral prophylactic oophorectomy, this can lead to premature ovarian insufficiency (POI). Therefore HRT is recommended until at least the age of 51.
We actually know that some HRT such as oestrogen only (usually for women who have had a hysterectomy) does not increase the risk at all. And there actually seems to be a lower risk when taking micronised progesterone and dydrogesterone (usually taken in combination with oestrogen by women who have not had a hysterectomy)
The bottom line is that HRT often doesn’t pose any more significant increased risk of developing breast cancer than if you are overweight, have never had children or have a couple of glasses of wine a day.
It is important to consider managing some of your lifestyle factors that can be modified to further reduce your risk. As I mentioned, regular alcohol intake can increase risk of developing breast cancer as can obesity. Reducing your alcohol intake and addressing your nutrition and activity is a good start to further decreasing your general risk.
Who can’t take HRT?
- Some cancers might impact your ability to take HRT. Most cancers are not hormone-dependent and there are many female cancers that are also not oestrogen sensitive. Some types of ovarian cancer would need careful consideration as would endometrial cancer depending on the stage and type of cancer. It doesn’t completely rule it out but you might benefit from involving your oncologist for advice.
- A history of blood clots. Although, again, this isn’t an absolute no. A full history would be taken by your doctor but for oestrogen-only treatments, there is no increased risk associated with blood clots and HRT.
- Uncontrolled high blood pressure. This won’t rule out HRT but you will need to have it controlled as this is beneficial in general for your health. Some HRT is actually proven to reduce blood pressure. Elevated blood pressure can lead to an increased risk of stroke. Management of high blood pressure could mean taking medication or making some lifestyle changes to try and reduce it. That would involve, a healthy balanced diet, reducing your salt intake, reducing alcohol intake, stopping smoking if you’re a smoker and exercising more. To be fair, all things that would make this menopause thing a whole lot easier anyway so might be worth doing it in general!
- Liver disease. Again, it’s not a complete no but you would need to discuss it with your GP. Evidence is limited but it suggests that non-oral routes of HRT administration would be safest to avoid it passing through your liver.
- Pregnancy. It’s still possible to get pregnant when you’re taking HRT. IT IS NOT A CONTRACEPTIVE! It can also increase your fertility. General medical guidelines suggest that if you’re under 50, you should use contraception for 2 years after your last period. If you’re over 50, contraception for 1 year.
Types of HRT
HRT comes in many forms and can be taken in a number of ways. Like other medications such as antidepressants and painkillers, some will suit better than others. There will likely be some trial and error involved in finding the right one for you if you do decide to take it.
There are 2 types of HRT. Oestrogen-only and a combined HRT which contains oestrogen and a form of progesterone. Which regime you are prescribed will depend on your history. For example, if you’ve had a hysterectomy, you will likely be given oestrogen. However, if you still have your uterus, it’s important to have progesterone as this prevents the lining of the womb from becoming too thick. A build-up can increase your risk of womb cancer. Taking combined HRT completely reverses this risk.
HRT is also taken in a number of different ways. It can either be an oral tablet, a skin patch, gels, pessaries. implants or an IUD. At the moment in the UK, there are around 50 different HRT preparations.
There are also different treatment plans. For example, some of the combined HRT’s will require you to take oestrogen every day and then progesterone for so many days every month or 3 months. What you end up with will largely depend on your medical history. This is why careful consultation is required with your GP to make sure you have the right one for you that poses the least risks.
How long can I take HRT for?
There is no time limit for how long you can take HRT. Some women are known to be taking it in their 80’s! Albeit this is probably to help with lessening the risk of osteoporosis and not because they’re still having hot flushes (mind you, that’s not unheard of too though!). The point is, you can take it for as long as you need it. Once you start, it would generally be advised to keep taking it for 5 years then stop and assess if your symptoms are still there. If they are, you can continue. For women in early menopause or surgical menopause, it’s recommended to continue taking HRT until the average age that natural menopause would occur which is about 51 years old.
Oh, and it’s a total myth that HRT just delays your symptoms. If your symptoms come back after you stop HRT it’s not because of the HRT. It’s because you would have still been having the symptoms even if you hadn’t started it.
Are there side effects?
As with any medication, there can be side effects when taking HRT. The good news is though, that they will often resolve within 3 months so it is always best to try and persevere.
The most common side effects are:
- breast tenderness
- leg cramps
- stomach pain
- irregular bleeding
The good news is though, that many of these can be managed with some lifestyle changes or taking an additional medication for a short time until it passes. Experimenting with taking it at different times of the day or taking it with food can also help.
Obviously, you know your history and it’s always worth doing some research before you see your GP to make sure you’re informed. As you can see from this post, it’s not just a simple case of rocking up to your GP and asking for a prescription for HRT. There is a lot to consider and that means your GP may also need to take some time to review your history properly.
If you want some help with exploring your best options before seeing your GP, please get in touch to speak to me about a one-off session to review your current symptoms and history. This can help you get insight into what sort of lifestyle changes might help as well as helping to decide whether HRT is right for you and what you might need to discuss with your GP before taking it.
I hope this has been helpful in giving you a balanced view of what HRT is and things to consider before you take it. Please comment below with any views or questions.