Is Hormone Replacement Therapy (HRT) For Menopause Right for you?
Of all the things to navigate during perimenopause and menopause, there’s nothing more polarising than the topic of Hormone Replacement Therapy (HRT). Since a study in 2002 linked HRT with breast cancer, there have been increasingly dramatic headlines about the risks, leaving many women feeling overwhelmed and without options.
Thankfully, these treatments have come a long way over the past two decades. Deciding whether HRT for menopause is right for you, begins with understanding what it is, weighing up the benefits and having an informed conversation with your doctor.
What is Hormone Replacement Therapy (HRT)?
HRT, also known as Menopausal Hormone Therapy (MHT), covers a range of treatments that replace falling levels of hormones during the menopausal transition.
Oestrogen plays many roles in our bodies and affects our uterus, breasts, brains, heart, skin, bones and more. This is why the drop in levels during menopause can cause symptoms like hot flushes, night sweats, irritability, sleeping difficulties, vaginal dryness and urinary symptoms.
The job of HRT is to top-up and stabilise these hormone levels. While it is not a panacea, it can be an effective way to control menopausal symptoms and offers other health benefits like increasing bone density.
What are the different types of HRT?
When it comes to HRT for menopause, there is no one-size-fits-all approach. It comes in several forms, and finding the right one for you will depend on your symptoms, medical history, and lifestyle.
A great place to begin is understanding the two main combinations of HRT that are widely available:
Oestrogen-Only HRT: Typically prescribed to women who have had a hysterectomy.
Combined HRT: This includes both oestrogen and a progestogen and is for women who still have their uterus. The reason for the combination is to help protect the lining of the uterus from endometrial cancer.
These come in a range of options including tablets, patches, gels and vaginal treatments. Which leads us to the next breakdown of HRT for menopause:
Systemic HRT: which is absorbed into the bloodstream and your entire body, treating body-wide menopause symptoms.
Vaginal oestrogen: a cream or pessary used inside the vagina that can help treat vaginal dryness and irritation.
Image courtesy of Australian Menopause Society
Who can benefit from HRT?
In terms of the science, HRT is the most effective treatment for the symptoms of perimenopause and menopause, providing relief and improving the overall quality of life in the majority of women. This is true for not only the physical symptoms, but HRT can also help improve mood and mental health.
What are the risks and side effects of HRT?
While the side-effects of HRT can include headaches, breast tenderness and spotting, most women are concerned about the long-term risks.
A study in 2002 publicised an apparent increased risk of breast cancer in women who took HRT, though newer evidence has shown this risk to be very low - about the same as having 2 glasses of wine a night. HRT, when used for up to 5 years, is considered a safe treatment for most women. The risks of HRT also vary depending on:
Age: If women start HRT before the age of 60 or within 10 years of menopause and are in good health, the risks are typically low.
Health history: You need to consider your health journey up until this point and weigh up family history and any predisposed risks of cancer, heart disease, stroke, blood clots, liver disease and osteoporosis.
Hormone therapy: The risks will vary depending on the dose, delivery method and whether an Oestrogen-only or Combined HRT is used.
It’s important to weigh up the risks and benefits with a medical practitioner based on your individual health history. Whether you choose this option or decide to go through menopause without HRT, the best choice is an informed one.
Is there a connection between HRT and weight gain?
Many women worry that HRT will make them put on weight, but there is no evidence connecting HRT and weight gain. Weight gain is common as we get older regardless of whether you take HRT or not. This is why regular exercise and maintaining a balanced diet, are important contributors to midlife health and are an essential part of any healthcare plan.
It’s ok to feel unsure about using HRT for menopause. Equally, it’s ok to choose to transition through menopause without HRT. If you choose not to go down the HRT Path – there are other best evidenced-based tools involving diet, exercise, pelvic health and mental health.
The most important thing is to step away from google and consult a trusted doctor and then allied health professionals who can help you navigate the options and help you flourish.
Looking to navigate this journey from peri to post menopause well?
Let us help! Book your first appointment with Ponti Health today!