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HRT & Menopause

The menopause can cause various symptoms such as hot flushes and changes to your vagina. Hormone replacement therapy (HRT) may ease symptoms. If you are considering taking HRT, Richard will be happy to discuss the risks and benefits with you. If you are taking HRT, you should have regular check ups to decide whether or not treatment is still needed.

What is the menopause?

The menopause is defined as your last menstrual period. However, most women think of the menopause as the time of life leading up to, and after, their last period. It can take several years for a woman to go through the menopause completely. Women are said to have gone through the menopause (be postmenopausal) when they have not had a period at all for one year.

What causes the menopause?

As you get older, your ovaries stop producing eggs and make less oestrogen (the main female hormone). The average age of the menopause in the UK is 51. Your menopause is said to be early (sometimes called premature) if it occurs before the age of 45.

What are the possible symptoms of the menopause?

The menopause is a natural event which every woman will experience at some point. Some women experience few or no problems. However it is common to develop one or more symptoms which are due to the low levels of oestrogen. About 8 out of 10 women will develop menopausal symptoms at some point.

Symptoms can persist for several years, with more than half of women experiencing symptoms for more than 7 years.

The most common symptoms that women experience are:

  • Hot flushes . A typical hot flush lasts a few minutes and causes flushing of your face, neck and chest, and can be associated with sweating. Some women also develop palpitations and feelings of anxiety. The number of hot flushes can vary dramatically from woman to woman.
  • Sweats commonly occur at night and in some cases are so severe that sleep is disturbed.
  • Vaginal dryness.
  • Other symptoms may develop, such as headaches, tiredness, being irritable, difficulty sleeping, depression, anxiety, aches and pains, loss of libido (sex drive), and feelings of not coping as well as before.

What is hormone replacement therapy (HRT)?

Hormone replacement therapy (HRT) is available to ease the symptoms of the menopause.

All types of HRT contain an oestrogen hormone. HRT is available as tablets, skin-patches and gels. All types deliver a set dose of oestrogen into your bloodstream.

Unless you have had a hysterectomy, you will also need to take a progestogen hormone along with an oestrogen. This is to protect the lining of the womb (uterus). In many HRT products, the oestrogen and progestogen are combined in the same tablet or patch but they can also be taken separately.

What are the benefits of hormone replacement therapy?

  • Menopausal symptoms usually ease, which makes a big difference to quality of life for most women.
  • HRT tends to stop hot flushes and night sweats within a few weeks.
  • Symptoms of vaginal dryness usually improve.
  • There is some evidence that HRT improves your mood and your sleep.

What are the risks in taking hormone replacement therapy?

There has been a lot of media attention and controversy about the risks of taking HRT. This has been due to the findings of 2 very large studies being published then re-interpreted some years later. These were the Women’s Health Initiative Study in the USA and the Million Women Study in the UK. These studies raised concerns over the safety of HRT, particularly over a possible increased risk of breast cancer with HRT and also a possible increased risk of heart disease. However, it is important that the results of the studies are looked at carefully. HRT does increase your risk of developing certain problems but this increase in risk is very small in most cases.

The main risks are:

Venous thromboembolism

This is a blood clot that can cause either a deep vein thrombosis (DVT) in your leg. In some cases the clot may travel to your lung and cause a pulmonary embolism (PE). Together, DVT and PE are known as venous thromboembolism.

Stroke

There is a small increased risk of stroke in women taking certain forms of HRT.

Breast cancer

You may have a small increased risk of breast cancer if you take HRT. This risk increases the longer you have used HRT. When you stop taking HRT you have the same risk of breast cancer as someone who has not taken HRT.

Cancer of the uterus (womb)

There is an increased risk of cancer of the uterus due to the oestrogen part of HRT. By taking combined HRT containing oestrogen and progesterone, this risk reduces significantly. This is the reason why progestogen is included in HRT. However, you should always see your doctor if you have any abnormal vaginal bleeding which develops after starting HRT. For example, heavy bleeding, irregular bleeding, or bleeding after having sex.

Cancer of the ovary

There is a slightly increased risk of developing this cancer if you take HRT. This risk decreases after you stop HRT.

For the majority of women, for short-term treatment of menopausal symptoms:
If you are troubled with menopausal symptoms, the balance of risks and benefits is probably in favour of taking HRT (provided there are no reasons why you shouldn’t take HRT). You may be happy to accept the small risk of taking HRT for 1-3 years to be free of symptoms. You should take the lowest dose which keeps symptoms away. Many women find that after 1-3 years the worst of the flushing-type symptoms have gone and they no longer need HRT to prevent them. In some women, the symptoms can return for a short time after stopping HRT. If the genital symptoms such as vaginal dryness persist after stopping HRT, an option is to use, for example, an oestrogen cream or pessary in the vaginal area.

What to do next

Richard has been treating women with symptoms of the menopause for many years, if you are worried, confused or concerned about taking HRT, have menopausal symptoms and want to discuss your options, please contact us for help, advice or to make an appointment.