The big HRT rethink
Forget everything you thought you knew about hormone replacement therapy. Views on their risks and benefits are changing
Q So what’s the latest thinking? That, far from being a risk to women’s health, hormone replacement therapy (HRT) is not only the most effective way to deal with many menopause symptoms, it may actually improve women’s health. Some experts say that oestrogen reduces the risk of heart disease (statistically a bigger threat to women’s health than breast cancer), dementia, osteoporosis and certain cancers – and that it actually increases a woman’s overall life expectancy.
Q What about the risk of getting breast cancer? The risk was highlighted in a 2002 study by the Women’s Health Initiative (WHI), which linked HRT to an increased risk of breast cancer, stroke and heart attack. But critics point out that the study was flawed and inaccurate – the breast-cancer risk was, in fact, statistically insignificant (you have a higher risk of breast cancer if you’re overweight or you don’t exercise), and the HRT type studied was different from the HRT prescribed now.
What’s more, the average age of women used in that research was 63, when most would have started on HRT more than 10 years earlier,) when menopause symptoms start and are usually most severe. The group also had a higher than average collection of pre-existing health problems – half were ex- or current smokers, around 70% were overweight or obese, and over a third were being treated for high blood pressure, all of which would have raised their risk of a host of health conditions, including heart disease, stroke and certain cancers.
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Q What symptoms can HRT help alleviate? It abolishes the main ones – hot flushes and sweats, and vaginal dryness caused by low oestrogen levels (detectable using blood tests).
Woman’s Weekly’s Dr Mel Wynne-Jones says, ‘It often helps linked symptoms such as sleep disturbance, tiredness, aches and pains, irritability, low sex drive, urinary irritation/incontinence, anxiety and/or depression – although sometimes these are actually due to thyroid or other medical conditions instead.’
Longer term, low oestrogen levels reduce tissue-supporting collagen and can lead to wrinkles, pelvic-floor weakness and thinning bones – although HRT isn’t prescribed specifically to prevent osteoporosis. Q What are the different types of HRT available? There are many – your GP can help you decide which, if any, will suit you best.
If you’ve had a hysterectomy, you’ll only need oestrogen. If not, you’ll also need a progesterone-like hormone to prevent overstimulation or cancer of the womb lining. This can be prescribed as tablets or as the Mirena intra-uterine system (IUS), which also provides contraception.
Periods continue with cyclical combined HRT, but if it’s more than a year since they stopped, you can take continuous combined HRT with which you’ll have no bleeding.
Oestrogen-only HRT can be given as tablets, skin patches, gels, implants, vaginal rings, or as a vaginal cream or pessaries. Tibolone, which stimulates oestrogen receptors but contains no oestrogen, may also be effective.
Some women find progesteroneonly HRT or ‘bio-identical’ hormones help, although more research is needed to clarify the risk/benefit balance Q So should I go on it? That’s a decision only you can make, in consultation with your GP. No drug is completely free from potential side-effects. Some women on HRT suffer from breast tenderness or irregular bleeding, but altering the prescribed dosage, in consultation with your GP, can often alleviate these. Oestrogen as a tablet (instead of a patch or gel) can also marginally increase your risk of a blood clot. But the change in thinking around HRT should make you more willing to see your GP to talk about menopause symptoms which are affecting your life.
In recent years, women have thought the menopause is something they have to simply put up with, says TV doctor Pixie McKenna: ‘When it comes to HRT, we have done women a great disservice, and we have de-skilled ourselves as GPs.’ But things are changing.