Hormone Replacement Therapy Guide 2019:
Should I take it?
Are there risks?
Are there benefits?
Who should I listen to?
With all the recent media coverage and sensationalistic headlines it becomes very confusing doesn’t it to know what to do and who to trust when it comes to HRT, but more on that subject later. Let’s get some facts straight…
What you need to know about HRT during Menopause…
- For the majority of women the benefits greatly out way the risks.
- Every woman should discuss with their GP on an individual basis those benefits and risks pertinent to their own medical history.
- There are many different types and combinations of HRT (over 50), so it might take a little time to find the right combination for you.
- Your prescription is only as good as your prescriber – make sure you see a GP with an interest in women’s health who knows what they are talking about. Or alternatively go onto the British Menopause Society (BMS) website punch in your postcode and find out where your nearest menopause specialist is who you can be referred to.
- HRT consists of oestrogen and progesterone, oestrogen alone HRT is only prescribed for women who no longer have their womb/uterus (following a hysterectomy). The progesterone is taken to protect the womb lining (endometrial lining).
- If you start taking HRT you should be assessed after 3 months, then 6 months and then after that have an annual assessment
- If prematurely menopause (POI) so before the age of 45 years, HRT should definitely be considered and options discussed with your GP.
- HRT can treat a variety of symptoms including hot flushes and night sweats. It can also help with the lesser known symptoms like joint aches and reduced sex drive, it can have very positive results with psychological symptoms and with the vaginal, urinary symptoms.
- Some women have particular problems with vaginal symptoms and require additional localised treatment with their systemic treatment. This is in the form of pessaries, creams or a vaginal ring. Remember vaginal symptoms are classed as one of the long term symptoms.
- HRT remains licensed for osteoporosis prevention and as such is the preferred choice for women starting treatment below the age of 60 years.
- Never buy hormones off the internet or take hormones which haven’t been prescribed for you.
How can you take HRT…
There are different ways you can take HRT:
- Orally (in tablet form via mouth) this is the most common way.
- Transdermally (through the skin) either as gel, (oestrogen only) or as a patch. Patches can either be oestrogen only or can be a combined patch. Transdermally is the preferred route by many menopause specialists as it has less side effects.
- Subcutaneously – an implant is injected beneath the skin to provide slow release oestrogen over several months.
- Vaginally – pessary, cream or a ring (inserted and changed after 3 months).
- The progesterone part of HRT can either be taken combined with oestrogen in tablet form, taken as a separate tablet with oestrogen e.g. being delivered via a patch or there is the option of an ‘Intrauterine’ device as in the Mirena coil which slowly releases progesterone.
Note : the Mirena coil should be replaced after 5 years of use.
One question a lot of women ask me is… when do I know I need HRT. This is a very personal decision and one that should be made with an experienced Health Care Professional. But if your symptoms are affecting the quality of your life, and you have addressed your lifestyle choices then it can definitely be an option for you to consider.
So what are the risks of taking HRT…
It is very important when trying to understand the potential risks of taking HRT to put everything in perspective.
The various medical surveys and research out there report an increased risk of breast cancer after taking continuous HRT therapy for more than 5 years in less than one in 1000 women. What the media headlines don’t tell you is that HRT is thought to accelerate cells already present so acts as a promotor rather than an initiator of cancer.
As always, any medication risks should be discussed with a medical professional based on each woman’s individual physiology and medical history.
In sharp contrast you are much more likely to be at risk of developing breast cancer and other potential long term health issues e.g. cardio vascular problems if you are overweight or obese and if you drink excessively.
Which is why I bang on about lifestyle choices continually wherever I go and here at Fountain Retreats by the end of your stay you will realise the benefits of choosing a healthy lifestyle.
If you are well nourished, have a healthy, balanced diet, are well exercised and manage to fit in some relaxation along the way the better your body will be able to cope with not only any menopausal symptom that comes along but will help you and your body have a better quality of life long term.
So that is a whistle stop tour of the benefits and risks of HRT but what if you decide HRT is just not for you, if you are unable to take HRT due to other medical reasons or you’ve tried it and it just didn’t suit you…
Lifestyle choices as just mentioned are essential to look at but there are alternative remedies and therapies out there which can be beneficial and we will look at those in another post soon…
A small postscript…
Sensationalistic headlines… they create panic and confusion. Journalists should have more stringent guidelines to adhere to when reporting on anything to do with the medical world. Personally I would trust the views of any menopause specialist working within the field of menopause with years of experience rather than a journalist.
As such if you would like reassurance about the taking of HRT instead of soaking up misleading headlines go to the people who really know what they are talking about. The Womens Health Concern which is the patient arm of the BMS is an excellent, accurate resource and has brilliant fact sheets : www.womens-health-concern.org. For any HCP out there go to the British Menopause Society website : www.thebms.org.uk.
I certainly know who I would be trusting!
A recent statement from the BMS states : ‘we believe that arbitrary limits should not be placed on the dose or duration of usage of HRT. The decision whether to take HRT, the dose of HRT used and the duration of its use should be made on an individualised basis after discussing the benefits and risks with each patient.’
'As with any information developed for Fountain Retreats the information in this post is accurate at time of posting and is for information purposes only. It is not intended to replace or substitute the judgement of any medical professional you may come in contact with. You should always seek advice from your health care professional regarding a medical condition’
About the author...
Author, Qualified Nurse
Ruth is a qualified nurse, gaining her registration and working at the Edinburgh Royal Infirmary.
She is passionate about providing women and employers with evidence based information and support, helping women to make informed decisions about how to manage their menopause and so improve their quality of life.
She has been asked to contribute on several occasions on various media platforms including, Radio 4s Woman’s hour, BBC Radio Scotland, Radio Borders, the BBC Insiders Guide to the Menopause documentary with Kirsty Wark and BBC breakfast.
Ruth is married with three children, three dogs and a cat, loves cycling, playing netball and tennis, spending time with family and friends and has a great sense of humour.
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