HRT throws up a number of concerns, whilst at the same time potentially throwing us a lifeline and way out of the hormonal vortex that perimenopause and menopause can bring. The media has a way of sometimes sensationalising and distorting the facts until we don’t know what to believe. So, the truth behind HRT and the decision to take it or not is a topic to investigate for ourselves.
What is HRT?
As we enter periomenopause and menopause our bodies no longer produce two key hormones – oestrogen and progestogen. Falling levels of these two hormones can result in mood swings, hot flushes and vaginal dryness, among a number of challenging symptoms.
HRT is hormone replacement therapy that literally replaces these hormones. The options are to take a combination of both or just oestrogen (this is usually for women who have had a hysterectomy). HRT comes in a variety of forms – tablets, gels, sprays and skin patches. You can also have an HRT implant or vaginal cream, pessary or ring.
More information on each of these delivery methods can be found on the NHS website here.
How can it help?
If you read up on the function of oestrogen in the female body it’s easy to see why we might be found queuing outside the doctors in a long line demanding our share! It can affect our cholesterol levels, brain and heart function, osteoporosis, vaginal dryness, protect our skin from the signs of ageing (give me more!) and bladder control. Having said all that, too much oestrogen is dangerous and is linked with blood clots, stroke, fybroids and gall bladder inflammation.
Why would we consider HRT?
Honestly I think the only time to consider HRT is if you are experiencing menopausal symptoms that are making life uncomfortable, intolerable or just plain miserable. If you are having mild symptoms and feel generally well, I’d skip to the end of this article and look at lifestyle changes before taking any further action. Maybe you’re already doing everything well and still feel as though you need some further help. I’ll always repeat my recommendation that you should do what’s right for you, there’s no judgement here.
What are the pros?
Once you have found the right HRT treatment for your specific needs, the main benefit will be a relief of some or all of your menopausal symptoms. You would be expected to see a significant improvement in any hot flushes, night sweats, mood swings, vaginal dryness and sex drive.
What are the cons?
The cons are quite well publicised and include a link to breast cancer which is why HRT has had some bad press in recent years. However recent research concludes that breast cancer is common and HRT alone doesn’t increase the risk by any significant amount. The thinking is that there are many factors to consider if we’re looking to mitigate the risks of breast cancer: regular NHS breast screening being one.
“Oestrogen only HRT shows no change to the risk of breast cancer, while combined HRT is associated with a small increased risk. The risk is related to how long you take HRT and it falls after you stop taking it” [source NHS.uk].
There’s no increased risk of blood clots from HRT patches or gels, and just a small risk if you take HRT via tablets. In relation to heart disease and strokes, “HRT does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age, and may reduce your risk” [source NHS.uk].
Lifestyle changes
You might roll your eyes, but key menopausal advice is to practice that long list of things that are good for us such as eating and sleeping well, exercising, cutting down on caffeine and alcohol, giving up smoking, relaxing and reducing our stress levels. It’s no coincidence that this advice appears in almost every article I write.
The British Menopause Society has created a visual pdf that shows its perspective on the HRT and breast cancer link, based on medical findings. It’s quite an eye opener and well worth adding to your decision making. View or download it here - also pictured on this page. What I took from this is that being overweight/obese is far more of a risk than anything else, and way more risky than taking HRT. For women who manage 2.5 hours moderate exercise per week, the risk of breast cancer is significantly lower than average. So maybe the eye-rolling advice is our baseline. However we view the facts, looking after ourselves with an improved quality of life is never going to hurt is it?
Ultimately it’s our bodies, our lives and our choice so we need to weigh up what’s right for ourselves individually. I am a qualified clinical psychologist with additional qualifications and a keen interest in menopause – and here to talk through the options and effects of ageing, mental health and the menopause if you need some professional support.
References
https://thebms.org.uk/wp-content/uploads/2023/01/WHC-Infographics-JANUARY-2023-BreastCancerRisks.pdf
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