Menopause

HRT is a very successful treatment for the symptoms of menopause, and there are many different varieties; the main goal is to restore oestrogen levels so that the symptoms settle. If you’re still having periods, it may be that cyclical HRT, containing oestrogen and progesterone, would be most suitable for you, and much like when taking the combined pill, you would have regular bleeds.

If your periods have stopped, then ‘continuous combined’ HRT (where you take a little oestrogen and progesterone every day) may be more suitable. If you’ve had a hysterectomy or have a Mirena coil (which contains progesterone), you may only need to take oestrogen.

HRT comes in different forms. There has been a move to use transdermal (through the skin) forms of oestrogen (e.g. in a patch, gel or spray), as there are additional risks if oestrogen is taken in an oral format.

For vaginal dryness and pain during sex, topical oestrogen can be used to boost tissue robustness and elasticity of the symptoms, and it can dramatically reduce discomfort.

Body-identical HRT is a pharmaceutical-grade form of HRT- the hormones are exactly the same as those you naturally make. They are stringently tested and regulated. Bioidentical hormones are compounded, unregulated medications and are not approved by the British Menopause Society. I don’t use bioidentical HRT in my practice.

Women who have been affected by low libido may also benefit from testosterone in their HRT regime.

In addition to improving the symptoms of menopause, HRT has some additional health benefits, including a reduction in the risk of heart disease, improved brain function, and a reduction in the risk of osteoporosis (loss of bone mineral density). It has also been shown to reduce the risk of colorectal cancer.

HRT is not a contraceptive, and the general recommendations are to continue contraceptive use for two years after the last menstrual period for women under 50 years old, and for women over 50, contraception should be used for one-year post-last period. For any woman who is uncertain if she has reached menopause, it is suggested to continue contraception until age 55.

We now have an excellent understanding of the risks and benefits of taking HRT and know that if you’re under 60 years of age and you don’t have a history of breast cancer (or a high risk of developing it), the benefits of taking HRT will likely outweigh the small risks.

If you’ve had breast cancer, HRT is typically (although not always) contraindicated.

There is a small risk that taking combined oestrogen and progesterone hormone replacement therapy (HRT) may increase breast cancer likelihood.

To put the risk into context, statistics show approximately five additional cases of breast cancer per one thousand women who use combined HRT for five years.

It’s important to note the risk seems to go up the longer HRT is used and the older a woman is. However, the risk does appear to revert closer to average after discontinuing HRT. When it comes to oestrogen-only HRT for women who have had hysterectomies, research indicates there is no elevated breast cancer risk.

HRT tablets have been shown to slightly increase the risk of blood clots, although the risk is minimal (around nine extra cases in 10,000 women taking HRT). The good news is that HRT in the form of patches, gels and sprays don’t increase the risk of blood clots, even if you’ve had a blood clot in the past.

If you’re taking HRT and are under the age of 60, your risk of developing a stroke because of the HRT is minimal and is less than 1 in 1,000.

If you’re struggling with menopausal symptoms, have not yet found success with HRT, or if you’re looking for specialist input because of previous health issues, please come to see me; I’d be delighted to help you.