Menopause and HRT
A change doesn’t have to be for the worse
Davina McCall’s recent HRT campaign is most welcome and I’m glad someone prominent is urging women to come forward to discuss menopause with their doctor. Nobody should not have to suffer what can sometimes be really disabling symptoms now that we have proven safe and effective treatments. Many women think they need to wait for periods to stop or have symptoms before starting treatment, which is not true. Some think it’s too late - not so, although with age the risk/benefit balance can change. If you have concerns about side effects, or you feel it’s your duty to just ‘get through it’ then please have a chat with a doctor - you may in fact be pleasantly surprised by what you find out.
What are the symptoms?
There are a range of symptoms, and everyone seems to suffer differently. At the lighter end of the spectrum people have almost no symptoms, and that’s great, but read on and you’ll discover why it might still be worth considering HRT. For others there is any combination of excessive sweating, mood changes, disrupted sleep, aches and pains, brain fog, vaginal dryness, irregular bleeding or urinary problems. This is all due to falling oestrogen levels. Some women also start getting migraines which can be settled with HRT (although choice of HRT is important here).
What can I do about it?
Most importantly, talk to your GP. There are a number of things you can do to help. Firstly you can make tweaks to your day to day life if possible.
Take exercise - especially strength training and resistance exercises which help to keep bones and muscles strong. There are many body weight exercises out there, the most commonly known being pushups and situps, which require no equipment or gym membership.
Try to engage in something you find relaxing - it really can have physiological effects that will reduce your symptoms. Stress can really add to the symptoms of menopause.
If your sleep isn’t disrupted as a symptom but you’re depriving yourself of time in bed then try to improve your routine to get more sleep.
If you smoke, try to stop or cut down.
Alcohol can be detrimental too - try to cut that down if you can.
Secondly there are non-HRT things you can try.
Therapy, particularly for mood and anxiety symptoms. Cognitive behavioural therapy (CBT) is generally recognised to be the best form of therapy here, or at least has the most supportive evidence at present.
Supplements can help with flushes but do be careful where you get them from to ensure it’s a reputable and reliable product because these aren’t regulated in the same way medicines are. The benefits seem to be limited but it can be worth a try. Options are red clover, vitamins (especially B and D), iron, magnesium, and sometimes black cohosh. Do be aware though that herbal supplements can increase your oestrogen - good news if that’s what we’re trying to fix, but there are those for whom that is a bad idea (see below).
Eat well. A Mediterranean diet has a number of beneficial components that can help with menopause symptoms. Avoiding processed food and sugar is important.
Antidepressants can be really effective as well, but obviously also come with some potential side effects.
Next there is the idea of replacing that falling oestrogen with HRT. There are lots of different formulations now - patches, gels to rub into the skin, tablets, even a spray. If one hasn’t worked for you in the past don’t discount the principle as there are many alternatives.
What are the benefits of HRT?
First and foremost the obvious benefit is resolving those symptoms. However there is also the benefit of reducing the risk of osteoporosis. It seems that rates of dementia are reduced in those who are or have been taking HRT. Heart disease may also be reduced in younger women.
What are the risks?
There are some small risks worth considering as they aren’t negligible, but they remain very small and some of the modern HRT versions are much safer than they used to be.
Breast cancer - traditionally a significant concern, although the numbers were still relatively small, but with modern HRT the risks presented by obesity or excessive alcohol are actually greater
Blood clots (DVT in particular) - oral versions seem to present a higher risk, but generally risks are low and the newer progesterones are thought unlikely to increase the risk
Heart disease - after the age of 65 there may be a small increased risk.
Strokes - risk is generally very low in women around the age who would commonly be taking HRT, and the newer gels/patches are much safer, however there is evidence of a very small increased risk.
Ovarian cancer - slight increased risk
Unless you have had a total hysterectomy you need to have some progesterone along with the oestrogen to prevent uncontrolled proliferation of the womb lining and potential cancers - this is easily done though with a tablet, a hormonal coil like Mirena, a patch or a pessary.
Who can’t have it?
Unfortunately you may not be able to have HRT if you’ve had any of these, but do talk to the doctor as it’s not always black and white on this one.
Breast cancer and certain other oestrogen-sensitive cancers.
Blood clots
Uncontrolled high blood pressure
Liver disease
Vaginal bleeding without a diagnosis
What about bioidentical HRT and compounding?
In the past to get something more akin to your body’s natural hormones you had to go to a specialist compounding pharmacy where they’d make a bespoke HRT formulation for you. There is evidence that this is better for you. However the good news is that these are now more widely available forms of HRT, in the form of oestrogel and utrogestan, and for most these will control their symptoms. The requirement to find a compounding pharmacy is much less, but if you still wish to pursue this avenue you can do, just be careful that you know what you’re getting and that they’re fully regulated.
How do I get HRT?
You just need a consultation with a GP where you will chat through your symptoms, make sure you fully understand and are happy with the risks and benefits, and then a strategy and prescription can be agreed to address your symptoms. Within a short space of time you should be feeling much more like your previous self again!
