What is the menopause?
The menopause is when your body no longer produces adequate amounts of the hormones Oestrogen, Progesterone and testosterone, leading to periods stopping and other side effects. The average age of menopause is 51 years old while women going into menopause before the age of 45 have premature menopause.
What are the symptoms?
The most obvious symptoms are sudden feelings of heat and sweating known as hot flushes. Additionally, women can have low mood and depression, a decrease in sexual desire and function, vaginal dryness leading to painful intercourse. Furthermore, women tend to go to the toilet more frequently and may have more urinary infections. Finally, skin, collagen and connective tissue begins to significantly deteriorate after the menopause and bones begin to weaken (osteoporosis) leading to an increase risk of fractures.
What is Hormone Replacement Therapy (HRT)?
Hormone Replacement Therapy (HRT) is a treatment that involves replacing these hormones that your body no longer produces to restore them and relieve or reverse the symptoms of the menopause.
What are the benefits of HRT?
It significantly reduces hot flushes night sweats and other changes in body temperature,indeed this is the main reason that women take HRT.
Mood and Depression
It may improve mood and depression symptoms especially in the transition into menopause and the early menopause.
HRT has been shown to improve sexual function, including sexual desire and orgasm. It has also been shown to reduce vaginal dryness and irritation which can also cause painful intercourse helping to restore intimacy between couples.
It may help relieve symptoms of urinary frequency, urgency and possibly reduce the risk of recurrent urinary tract infections.
Oestrogen has shown to have a protective effect on deterioration of skin, and connective tissue and in some cases even reverses the process.
HRT is effective at preserving bone density and preventing osteoporosis. More importantly, it actually reduces the risk of fractures. Interestingly, although bone density does decrease when HRT is stopped some studies show a protective effect for many years after stopping.
There is some confusion around whether HRT helps heart disease because of different studies looking at people at different ages. What is clear is that HRT if taken within 10 years of the menopause can reduce coronary heart disease by 50%. This is often described as a “window of opportunity”. However, if HRT is started in someone who is above the age of 60, there is a small increase risk of coronary heart disease for the first 12 months.
Alzheimer’s and Dementia
In women who start HRT early, there may be a possible reduction in the long term risk of Alzheimer’s and Dementia. This is not the case if it is started in those greater than 65 years old.
What are the risks of HRT?
Breast Cancer risks
If oestrogen and progesterone are used for more than 5 years, there is a small 1/1000 or 0.1% increased risk of the incidence of breast cancer. However, if oestrogen alone is used, studies have shown a small but significant decrease in the risk of breast cancer.
The most robust studies show no increased risk.
Taking oestrogen alone does have an increased risk but oestrogen and progesterone taken together in continuous combined HRT have a lower risk of endometrial cancer than the general population.
Clots in the legs and lungs
If HRT tablets are taken, there is up to a 4 times increase in the risk of getting clots in the deep veins of the legs which may break off and go to the lungs. However, taking HRT in gel or patch form has no increased risk. As such, we recommend gel or patch HRT as the first line for all women.
There is a very small increased risk of stroke in women between the ages of 50 and 59. It is slightly higher in those greater than 60.
What kind of hormones can I take?
The key hormones used in replacement include oestrogen, progesterone and testosterone in varying concentrations and doses tailored to each individual patient. For example, those who have had their womb removed do not require progesterone, relying solely on oestrogen with or without testosterone.
Will I still have periods on HRT?
There are options both to have bleeds, or not to have bleeds depending on your needs.
What about natural or body identical hormones?
We recommend regulated bio identical oestrogen as they are exactly the same as the bodies natural hormones and they have a lower risk of side effects.
What if I went into menopause early?
It is imperative that women with early menopause less than the age of 40 are encouraged to use HRT at least until the average age of the menopause (51 years old). In theses cases, the HRT only replaces hormones that would have already been present, as such they confer no additional risk, unlike those starting it after the age of 51.
Should I take HRT?
The decision whether to use HRT should be made by each woman having been given sufficient information by her health professional to make a fully informed choice.
So what is the best regime?
Because of the complicated nature of the risks and benefits together with the fact that every women will need slightly differing requirements, the HRT dosage, regimen and duration should be individualized.
How often do I need it checked or changed?
Once a tailored, individualised, holistic regime is tested and working well, then a minimum of a yearly check and evaluation is all that is required.
How long can I be on it for?
There are no arbitrary limits to how long HRT can be used for, once again it is an individual decision between the patient and her doctor taking into account her symptoms and the risk. Usually, in women starting HRT at less than 60 years old, the benefits outweigh the risks. Above the age of 60, lower doses and creams and gels are preferable to tablets.
How long does it take to work?
Though effects are often felt within a few weeks, a full assessment of the effects wont be shown until 3 months of usage.
What about complimentary therapy?
At the Centre for Reproductive Immunology and Pregnancy, we believe in taking a holistic approach to both reproductive and post reproductive health. As such, not only do we consider HRT for menopause, but also complimentary therapies. Additionally, we look at other aspects including nutrition, vitamins, cardiovascular health, disease prevention and skin care and bone health.
In summary, HRT, when carefully and expertly, selected with individual tailoring and monitoring, can help greatly improve the quality of life of women in the menopause, whilst minimising any potential risk and side effects.