Wondering if HRT is for you? As newer forms of hormone replacement therapy arrive, Dr Anne Henderson weighs up the pros and cons of the treatment for relieving menopause symptoms…

Many women have had concerns about using hormone replacement therapy (HRT). But nowadays modern body-identical hormones have transformed the role of HRT during the menopause. The main hormone responsible for the changes occurring at the menopause is oestrogen. One of the primary aims of HRT is restoring oestrogen to a level that is sufficient to minimise menopausal symptoms. In women who have a uterus, progesterone is also necessary to keep the endometrium healthy and avoid any thickening, which can be caused by taking oestrogen on its own.

Should I try hormone replacement therapy for menopause relief?

Hormone replacement therapy is an effective way to reduce the severity of, or even prevent, many common but what can be debilitating symptoms. This includes hot flushes, night sweats and joint aches, to helping with insomnia, brain fog and anxiety. Hormone replacement therapy can also provide major health benefits for both your bones and heart. Taking HRT long term can help maintain bone density and reduce the risk of osteoporosis. It can also reduce the risk of heart disease and stroke.

How do I ask my doctor for hormone replacement therapy?

If you are considering a consultation with your GP, attend fully prepared. Unfortunately, many doctors are not fully up to date with current HRT research. This can lead to doctors offering women incorrect advice. If you feel this is the case, ask for a second opinion. Alternatively, you can ask to be referred to an accredited menopause specialist. Similarly, if you feel your HRT prescription does not suit you, look at different types or strengths of HRT. Often, you’ll need to frequently “tweak” hormones. It can also take four to six months to optimise the regime and control your menopausal symptoms.

What are the main benefits of hormone replacement therapy?

The most immediate and visible effect of HRT is that it can stop or reduce physical and psychological menopausal symptoms. Taking HRT has also been proven to prevent and stabilise the bone loss that occurs due to age and declining oestrogen at the menopause, even when taken at a low dosage. While there has been debate about whether HRT is good for the heart or potentially harmful, HRT taken ideally within 18 months of the menopause, can reduce your risk of developing cardiovascular disease. Timing is key, and evidence points to a “cardiovascular window of opportunity”. This is ideally within 10 years of the menopause.

Research has also found that oestrogen can maintain lower overall cholesterol levels. Regarding Alzheimer’s disease, there is conflicting research, but there is some evidence that HRT may help reduce the risk of Alzheimer’s and other forms of dementia. In terms of long-term health, HRT can help with weight management, muscle retention and may help delay the onset of Type 2 diabetes.

Are newer forms of HRT better?

Many women remain worried about the potential risks of HRT. However, current research is showing that taking the newer forms of HRT and starting treatment earlier, at the transition to menopause, can either reduce or eliminate these risks. Most information leaflets accompanying HRT prescriptions include a long list of potential cautions which you should consider before commencing treatment. Unfortunately, much of this information is outdated. Many of the risks have been overblown or disproven and may have changed due to the availability of newer and improved versions of HRT. While HRT is generally safe and beneficial for most women, it is important to understand the pros and cons of treatment. This will allow you to make a balanced decision about whether it is the right choice for you.

What are the risks of hormone replacement therapy?

While there are many potential benefits to HRT, there are also a couple of potential risks you should consider…

Risk of breast cancer

The risk of breast cancer is often the one that concerns women the most when starting HRT. This is understandable as there has been widespread coverage in the media. However, this does not accurately reflect the entire literature on the subject. Plus, breast cancer is very common, which makes it harder to determine what the underlying cause is in any one case. Oestrogen alone has not been shown to increase the risk of breast cancer. However, the data about progestogens and breast cancer is more mixed. It is thought that the real risk lies in women on combined HRT, taking both oestrogen and progestogen. Of key importance, the newer and increasingly used body-identical micronised progesterone has impressive data, showing its safety as far as breast cancer is concerned.

Risk of blood clots

Oestrogen as a hormone is associated with an increased risk of forming blood clots. This is true even of oestrogen made by your body. Oral forms of HRT including oestrogen are associated with a very small but definite increase in the risk of blood clots. However, this is not the case with body-identical oestrogen applied transdermally to the skin, such as patches, gels, or sprays, so are a safer option.
hormone repalcement therapy side effects

What are the side effects of hormone replacement therapy?

Most side effects tend to resolve with time, particularly after six to eight weeks of starting HRT. Some women can experience mastalgia (breast tenderness), abdominal bloating and headaches. Some of these may be dose-related. Therefore, you can minimise these symptoms by starting HRT cautiously and building up the dose. In women with a uterus, unscheduled vaginal bleeding can happen in as many as 40 per cent of women. This usually occurs in the first four to six months of treatment. However, this should not cause alarm in most cases. A surprising number of women are also relatively intolerant to progestogens. These women can develop symptoms that are similar to PMS. Fortunately, these tend to subside with time.

You can find out more about hormone replacement therapy and other treatment options for the menopause in Natural Menopause: Herbal Remedies, Aromatherapy, CBT, Nutrition, Exercise, HRT for Perimenopause, Menopause, and Beyond, by consultant editor, Anne Henderson (£14.99).

Click here for more advice on relieving menopause symptoms this summer.