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Hormone Replacement Therapy and Long Term Health

 

A Brief History of HRT

 

Hormone Replacement Therapy has had something of a roller coaster ride in popularity since it was first introduced to women in the UK in 1965.

There was widespread evidence in medical literature that oestrogen, in particular, successfully controlled menopausal symptoms but was also a key player in increasing bone health and reducing the risk of osteoporosis, reducing the risk of heart disease, colon cancer and Altzheimers.1

In 1993 a large clinical trial known as the Women’s Health Initiative began which explored the health effects on women taking oestrogen only or combined HRT (oestrogen + progesterone).    This trial was prematurely stopped in 2002 following findings that combined HRT showed an increased risk of breast cancer, heart disease, stroke and blood clots.

When the published findings from the prematurely terminated trial hit the media the use of HRT for the management of menopausal symptoms dropped dramatically, among fears that women were at a high risk of breast cancer.

Between 2004-2007 the Women’s Health Initiative results were re-investigated and results found that many of the risks had been over-estimated and in fact there were actually many additional benefits such as those already mentioned above.2

The Risks of Taking HRT

 

The current thinking on HRT is that it is an effective, low risk treatment for most women starting medication under the age of 60.

To put the risk in context, there is an expectation of 4 extra cases per 1000 women after 5 years taking combined HRT.  However this risk is significantly lower than for women who smoke 10 cigarettes per day, drink alcohol and who are obese.  For women taking oestrogen only HRT there is no increased risk of breast cancer.

HRT is the most effective treatment for hot flushes, but for me personally, its true superpowers lie in the long-term health benefits it can bring; improved bone density means lower risk of bone fracture, improved brain function means lower risk of dementia and improved heart function means a lower risk of coronary heart disease.  Not to mention some of the more intimate benefits such as a lower chance of vaginal dryness and painful intercourse.

The Types of HRT

 

There is a wide range of HRT available and it comes in various forms, dosages and ‘routes of delivery’ ie how it is administered.

Orally in tablet form

Transdermally  (via the skin) through patches, creams or gels

Implants under the skin

Progesterone can also be administered through the Mirena coil, an intrauterine device (IUD) implanted inside the womb that provides a slow release of hormones.

The most common form of HRT is a tablet however there is some evidence that transdermal application may have fewer negative side effects since it does not go through the digestive system.

With such a wide array of HRT options available it is likely that it may take some months and a bit of trial and error to find the combination and application option most preferred by each individual.  Often side effects will settle down after two to three months, therefore switching before then may not be beneficial.

For women who have a womb combined HRT should be prescribed, since the addition of progesterone stops the build up of potentially cancer causing endometrium.

For women without a womb the need to prescribe progesterone is negated and oestrogen only treatment should be prescribed.

The Myths Surrounding HRT

 

There are a number of myths surrounding the use of HRT, most of which stem from the now debunked findings of the WHI study.     Let’s talk about them here.

Myth Number 1:   If you take HRT you’re simply delaying the menopause

 

HRT does not put your menopause on hold.  It simply reduces or removes the symptoms.  If you gradually stop taking HRT and you begin to experience menopausal symptoms, for example hot flushes, it is simply that you are now experiencing symptoms you would have been having anyway.  Some women continue to experience symptoms for many years after menopause.  Coming off HRT can reveal symptoms that were previously managed.

Myth Number 2:   Natural remedies are better than HRT as they don’t contain chemicals

 

Whilst many products may be marked up as ‘natural’ they may be unsafe for a number of reasons.  Firstly most ‘natural’ products are unregulated and therefore their ingredients may be uncontrolled.  Just because a product is derived from a plant does not mean it is risk free, there are many plant chemicals that are harmful to the body.   Natural medicines may be contraindicated with other medications.  If you do choose to opt for a ‘natural’ approach, it is wise to speak to a qualified medical herbalist who can prescribe safely.

Many HRT medications prescribed through your GP are ‘body identical’ which means their structure is the same as the hormones in our body, and they are naturally derived from plant oestrogens – all very ‘natural’!

Myth Number 3:    You have to come off HRT after 5 years

 

There is no medical reason why a woman needs to stop taking HRT after 5 years, and indeed there is evidence to suggest that there are long-term health benefits in taking HRT indefinitely.   I think of it in this way.  If a person has Type 1 diabetes they supplement with insulin, because their pancreas fails to produce sufficient insulin.  Therefore if a women is peri or post-menopausal her ovaries fail to produce sufficient oestrogen, therefore supplementing with oestrogen meets that need.  There are many women happily enjoying the benefits of HRT well into their 80s.

Myth Number 4:   Your symptoms need to be debilitating before you can be prescribed HRT

 

How severe your symptoms need to be before you choose to take HRT is absolutely down to personal choice.  You have the right to decide when you feel the time is right to get help and you don’t have to wait until your symptoms are severe.    There is growing evidence to show that starting HRT early can help provide protection from conditions such as osteoporosis, heart disease and dementia so why would you wait?

Further Help

 

There are some extremely good GPs out there, but sadly, there are also some that are not so up to date on their menopause knowledge.    Often women feel uncomfortable challenging their GP, but doing a bit of personal research before booking an appointment can help.

Seeking out help from a menopause specialist can help you to clarify in your mind the best treatment route for you.

The British Menopause Society website has a menopause specialist tool to help you locate a specialist in your area, and lists both NHS and private clinics.

There are also online specialists that can help including Dr Morton’s – The Medical Helpline where, for a small monthly subscription, you can get easy access to a doctor or gynaecologist and you can also order your prescriptions directly from the site.

Peppy Health is a brand new service provided by Kathy Abernethy, former Chair of the British Menopause Society and her team of menopause specialists offering tailored advice to help you decide how you want to manage your menopause.

My Menopause Doctor is an online menopause advice service provided by Dr Louise Newson.  Dr Newson also offers private consultations at the Newson Health Menopause and Wellbeing Centre

Identifying Your Personal Menopause Management Plan

 

How you choose to manage your menopause is as individual as your menopause itself.  It’s important to consider your personal beliefs around menopause and your personal preferences.  Doing some research and considering your options based on facts rather than myths is so important.  And of course, what works for one woman may not work for another.  Whatever your preference, I would urge you to do your due diligence and make your decisions based on current evidence and not on misinformation.  I spent many years avoiding HRT through fear and ignorance.  Don’t let misplaced fear cloud your judgement.

 

References:

 

  1. Oestrogen Matters – Dr Avrum Bluming and Carol Tavris PHd 2018 – Piatkus
  2. Women’s Health Concern – https://www.womens-health-concern.org/help-and-advice/factsheets/hrt-the-history/ – 13 Aug 18

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