HORMONE REPLACEMENT THERAPY (HRT)
The case for and against HRT has flip-flopped over the past 50 years or so. Thousands of women stopped taking it in the 90s and early 2000s after a series of negative studies linked it to an increased risk of some cancers, blood clots and stroke. The pendulum has, however, swung back as we have more evidence about potential benefits and risks so arm yourself with all the facts…
What is hormone replacement therapy (HRT)?
A hormonal treatment containing oestrogen (and potentially progesterone) to replace the oestrogen that is no longer made naturally by the ovaries after the menopause.
What are the benefits of HRT during the menopause?
If you are having troublesome symptoms the benefits of HRT, on balance, appear to outweigh the risks for most women under 60. Starting it when you are over 60 is generally not recommended. HRT is not only statistically the most effective treatment for reducing hot flushes but it also appears to help improve mood, sleep, muscle and joint pain, vaginal dryness and libido. It is also known to help reduce the risk of osteoporosis (thinning of the bones) by helping to increase bone density. As well as been shown to reduce the risk of coronary heart disease if started within 10 years of the menopause although the evidence regarding HRT and cardiovascular disease is still largely controversial.
What are the risks of taking hormone replacement therapy?
It would be fair to say HRT has had something of a chequered history falling out of favour in the early 2000s when a series of large studies linked it to an increased risk of stroke, breast and endometrial cancer and gallbladder problems. Women who take combined HRT in tablet form are also known to have an increased risk of blood clots. Current thinking is that whilst HRT may increase your risk of some health problems, the risk is very small in most cases and generally, the benefits outweigh the risks. Those risks are also dependent on a range of factors including family history and lifestyle factors. You significantly reduce your risk of developing problems, however, if you have a healthy lifestyle – eating well, keeping your weight down, drinking moderately, taking regular exercise and not smoking.
Could HRT relieve my menopause symptoms?
If your menopausal symptoms are interfering with the quality of your life, then yes, HRT could help. Many women wax lyrical about how it has given them their ‘life back’ and made them feel ‘normal’ or ‘like themselves’ again.
How do you take hormone replacement therapy?
HRT is available in tablet form, as hormonal patches, creams, gels, nasal sprays or in the form of a vaginal ring. How you prefer to take it is largely up to you and the symptoms you present with. You can chat to your doctor about which seems the best delivery method for you.
What are the side effects of HRT?
Depending on the type of HRT you are prescribed side effects can include breast tenderness, headaches, nausea, bloating, leg cramps, backache, depression and bleeding (generally every 28 days but this can be irregular in the first three to six months). If you use HRT patches this can sometimes cause skin irritation.
What happens when you stop taking HRT?
When you come off HRT your body will be going from a high hormone level (courtesy of the HRT) to your natural levels which will be low. This can trigger withdrawal symptoms that can mimic menopausal ones. The advice is to come off it slowly – generally over a six-month period – with the help and advice of your doctor.
Who shouldn’t take HRT?
The NHS say HRT may not be suitable if you have a family and/or personal history of breast cancer, womb or ovarian cancer; have a history of blood clots; have high blood pressure or liver disease. If this is you, discuss alternatives to HRT with your doctor.
Ongoing HRT Care
If you are taking HRT you should have regular – generally annual check-ups. You should also do regular breast checks and be vigilant about any changes. See your doctor if you do notice anything that seems out of the ordinary and if you are over 50 attend your breast cancer screening appointment when you are called.
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