Time for a RETHINK?

In recent years, women have been reluctant to ask about HRT, but leading menopause specialist Dr Louise Newson wants to change that. Here, in an extract from her new book, she answers the most common HRT questions…

‘Hormone replacement therapy does what it says on the tin – it is a treatment to replace the hormones that you are deficient in,’ explains Louise. ‘As a result, HRT vastly improves your symptoms and helps protect against long-term health risks of hormone deficiency, including osteoporosis, cardiovascular disease, diabetes and dementia.

‘The most common type of oestrogen prescribed is 17 beta-estradiol. This is available as a patch, gel or spray and is derived from the yam, a root vegetable. It is known as a “bodyidentical oestrogen” because, unlike older forms of HRT, it has the same molecular structure as the oestrogen produced by our bodies. I also tend to prescribe micronised progesterone, which again is derived from yams and is a body-identical hormone.’

WILL HRT CAUSE WEIGHT GAIN?

Not if you are taking body-identical HRT. A combination of hormone changes, fatigue and stress-induced comfort-eating means it is common to gain weight during the perimenopause and menopause. The way our bodies store fat also changes. In earlier life, fat is usually distributed around the hips and thighs, but this becomes more concentrated around our middle. Many women who take HRT lose weight, do more exercise and drink less alcohol because they already feel much better.

DOES HRT CAUSE BREAST CANCER?

Women who are under 51 and taking any type of HRT do not have an increased risk of developing breast cancer, as they are simply replacing their missing hormones. Women who take oestrogen-only HRT (who have had a hysterectomy in the past) have been shown to have a 25% lower future risk of developing breast cancer. Reassuringly, there has never been a study showing that women who take any type of HRT for any length of time have an increased risk of dying from breast cancer.

HOW LONG CAN TAKE HRT FOR?

A lot of women – and healthcare professionals – wrongly believe there is a cut-off point for taking HRT. There isn’t. I have prescribed HRT to a woman in her 90s. It can be continued as long as it is needed, if the benefits outweigh any risks. This usually means for ever, because without HRT our hormone levels are going to be low. If you do continue, make sure you attend an annual review.

CAN I TAKE HRT IF I STILL HAVE PERIODS?

Yes, HRT can be started during the perimenopause. The earlier it is taken, the sooner it will work to improve your symptoms and boost your health. If you still have periods, even if they are irregular, you use oestrogen every day, and take progesterone alongside it for the last 12 to 14 days of your cycle. This will give you a bleed each month and is known as ‘monthly cyclical HRT’.

AM I TOO OLD TO TAKE HRT?

No, not if you are taking body-identical HRT. It’s important to take an individualised approach to managing menopausal symptoms: your healthcare provider should be looking at your age, your health history, your symptoms, and should take into account your wishes when recommending what treatment to start – or stop.

+ Preparing for the Perimenopause and Menopause by Dr Louise Newson (£9.99, Penguin Life). To log and share symptoms and get advice and support visit balance-app.com