Everything you need to know about HRT... but didn’t like to ask

What the experts think

Recently, a friend in her late 40s rang me in tears. Her marriage was falling apart because she’d become so insecure and her husband couldn’t cope. She kept having memory blanks during work meetings and her anxiety was so high she could no longer drive. Physically, she felt awful – her joints ached, her migraines had got worse and she’d put on weight because she no longer had energy to exercise. Her GP said she was perimenopausal and suggested HRT. ‘I’m not taking that stuff,’ said my friend. ‘I’d rather put up with this.’

Her take on HRT is not unusual. Women in midlife have heard horror stories, and it’s unsurprising they’re sceptical, particularly when GPs don’t always have the full facts.

A lot of the fears stem from a 2002 study that raised concerns about the increased risk of breast cancer and heart disease. The research has since been found to be flawed – the breast cancer risk was statistically insignificant (you have a higher risk of breast cancer if you’re overweight or don’t exercise), and the HRT studied was different to the type prescribed now. Yet women still shun HRT – and that’s sad when so many are suffering needlessly, says Dr Avrum Bluming, oncologist and co-author of Oestrogen Matters (£13.99, Piatkus). So, what is the truth?

WHAT IS HRT?

It is given in the form of supplementary hormones that replace what your body stops producing after menopause.

‘HRT has a protective effect on bones’

Most women take a combination of oestrogen and progesterone, which both deplete as part of natural changes.

If you have had a hysterectomy, you can take oestrogen without progesterone; otherwise, taking oestrogen alone can raise your risk of womb cancer – and progesterone has been shown to reduce this risk.

HRT can be taken as pills, patches or in gel form. If you have perimenopausal symptoms but are still having periods, your doctor will probably recommend cyclical HRT, which changes the dose throughout your cycle so you still get a bleed – that way, you’ll know when your periods stop naturally.

ARE THERE HEALTH BENEFITS?

Yes. ‘First, it can quickly ease troublesome menopausal symptoms, such as hot flushes, vaginal dryness and anxiety, which can have a huge effect on your quality of life,’ says Dr Heather Currie, gynaecologist and founder of menopausematters.co.uk.

But there may be longer-term health benefits, too. Dr Bluming explains HRT is the only medicine proven to help slash the risk of dementia – by 45-60%. ‘It is far superior to the small benefits from meditation or exercise, yet it’s not well known,’ he says.

HRT has long been established as having a protective effect on bones. We lose up to 20% of our bone density in the five years after menopause. For this reason, NICE guidelines recommend any woman who goes through an early menopause (before the age of 45) should take HRT.

BUT AREN’T THERE HEALTH RISKS?

Despite previous research showing HRT was safe, in 2002 the Women’s Health Initiative study found it increased breast cancer risk. But Dr Bluming points out that what this actually amounted to was an extra eight cases of breast cancer for 10,000 women taking hormones for a year.

Dr Bluming has looked at women >>