THE LATEST ON HRT

Hormone replacement therapy (HRT) tops up falling levels of hormones and is the most effective treatment for all symptoms. There are multiple brands, strengths and formats available, including tablets, skin patches or a gel to rub into skin. A tailor-made approach to HRT is common. For example, a woman might use a natural ‘body-identical’ oestrogen (with the same molecular structure as the oestrogen that decreases in your body), taken as a patch or a gel, plus micronised progesterone as a pill or Mirena coil. HRT also cuts the risk of osteoporosis.

IN THE NEWS

Concerns about links between HRT and heart disease have been discredited and, if started within six years of menopause, HRT may even reduce the risk of heart attack. Research on the Hrt/breast cancer link has shown conflicting results, ranging from no increased risk to the latest review showing an extra one in 50-70 women taking combined (oestrogen and progestogen) HRT for five years in their 50s being diagnosed with breast cancer. According to this same review, some excess risk appears to remain for at least 10 years, although the risk is smaller the less time you take HRT for. Also, the increased risk might be similar to that of a woman who is obese (with a BMI over 30).

HRT also has less serious side effects, including breast tenderness, headaches and vaginal bleeding. Tablet (not patch or gel) versions are also associated with a small increase in risk of blood clots. UK regulators advise HRT should only be used for significant symptoms, and at the lowest dose for the shortest time it’s needed.

SHORTAGES There have been widespread shortages of HRT since late 2018, with Lloyds Pharmacy supplier AAH Pharmaceuticals out of stock of 15 out of 24 brands. There’s little clarity as to the cause. The British Menopause Society posts availability updates on its website.

… AND THE ALTERNATIVES

If you can’t take HRT, or decide not to, your GP might suggest one of these:  Tibolone Similar to HRT, but may not be as effective. Only suitable for women who’ve been period-free for more than a year, it carries similar risk factors to HRT.

 Clonidine A non-hormonal medicine that might help reduce hot flushes and night sweats, although research suggests its benefit is limited.

 Antidepressants Some might help with hot flushes and night sweats, but have not undergone clinical trials for this use.

NATURAL THERAPIES

 Herbal supplements Some women find these beneficial, but there’s little good large-scale evidence, beyond placebo, to support their use. A few studies have shown that black cohosh could reduce night sweats and hot flushes, and there’s some limited evidence for red clover for hot flushes, sage for sweating, and agnus castus for Pms-like mood swings. But check with a GP or pharmacist first, as herbs can interact with some medicines.

 Bioidentical hormones Not to be confused with the ‘body-identical’ hormones your doctor can prescribe, these are hormone preparations made from plant sources. They’re not licensed or regulated and it’s unknown how safe or effective they are. They are sold through some private doctors and are often pricey. It’s worth noting that many standard HRT hormones are now made from natural sources but, unlike compounded bioidentical hormones, are closely regulated.