My view on Hormone Replacement Therapy (HRT) is that it is a very valuable treatment for some women going through the perimenopause but I do not believe that all women need it. In this blog I will explain why and if you are on Instagram, you can watch the Instagram live I did on this topic.
Let’s first confirm the terms I will use. The menopause is when a woman has gone for a year without having periods. After that she is post-menopausal. Before that she is perimenopausal. The perimenopause is a time that is often associated with a variety of symptoms which is mainly caused by the fluctuating levels of hormones. I have made a video on YouTube about the symptoms as I think it is essential for everyone to understand the symptoms.
Hormones are very strong substances. Throughout our menstrual cycle, some of our hormones oscillate up and down which can seriously affect us physically and mentally. So it is not surprising that during the perimenopause, as these hormones fluctuate, this can result in serious symptoms which can affect a woman’s wellbeing. Fluctuating hormones also happen during puberty. When a woman is post-menopausal, it can become more stable as our hormone fluctuations stop.
I think there are many positive aspects to being post menopause. One of the main ones is that we no longer have hormones going up and down each month, and no longer have periods or the issues relating to periods – such as premenstrual syndrome. I have done two key surveys on women’s views to the menopause and the majority of women are happy about no longer having a period. I describe my life when I was having menstrual cycles as a stormy, chaotic sea and since I have been post menopause, everything is calm, level and still. I feel like a mist was lifted from my brain.
I would describe being post menopause as being free – freedom from hormones, freedom from our menstrual cycles, freedom from our periods and freedom from contraception. This can be a key time for women to blossom and grow.
Some people have branded the menopause as a hormone deficiency syndrome which many of us take great offense to. This implies that all women have a syndrome that only drugs will correct. In many countries they do not even refer to HRT as HRT as they do not feel it is replacing something as it is not natural for post menopausal women to have hormones. They refer to it as HT for hormone therapy.
Personally I was very pleased to be stopping the strong cycling of oestrogen and progesterone in my body. They seriously affected me mentally and physically and I wanted to see what life was without it. And since I felt my menopause symptoms were manageable, this is why I never considered taking HRT. I finally felt free of my hormones.
But one part of today’s negative narrative is that all women need HRT forever. I have heard it being claimed it will keep women looking younger, improve their sex lives (maybe we discuss testosterone another day but in short – I have looked at the evidence and I cannot see any reason for taking it for most women), stop women getting Alzheimer’s and dementia and much more. HRT is not a preventative medicine and is not recommend to be used as such – at the end of this blog I will put the position statements from the key societies. This leads to the confusion that we are leading women into. We all want to increase the discussions around the menopause but now we have contradictions as we have two different points of view. Those who believe that ALL women need HRT as a preventative medicine and those who believe only some need it when they have symptoms. The recommendations coming out of Sweden suggest that maybe about a third of women may benefit from HRT.
So where is a woman supposed to get the correct information if some of the key players in the menopause arena are not in agreement?
I would suggest the British Menopause Society (BMS), and the Royal College of Obstetric and Gynaecology (RCOG) websites. I know some of the information there can be very complicated to read and I hope they make some patient friendly information very soon.
Here are some key documents:
The BMS, RCOG and the Society of Endocrinology produced a position statement this year. You can find the full article here. It says
For most women, initiating HRT has a favourable benefit/risk profile. However, HRT should not be used without a clear indication and should not be used for the sole purpose of disease prevention. Menopause is a life stage and does not represent a deficiency state.
The BMS issued a statement on 16th June 2022:
recommend an individualised and comprehensive approach that includes advice on exercise, optimising weight, stopping smoking, and reducing alcohol consumption as well as management options such as hormone replacement therapy (HRT).
The main indication for HRT remains control of problematic menopausal symptoms and improving quality of life.
HRT may help relieve short term cognitive symptoms related to the menopause, but this should be clearly differentiated from dementia prevention. Evidence does not support use of HRT to reduce the risk of dementia.
The balance of benefits and risks, however, does not support use of HRT for primary or secondary prevention of disease, and international guidance recommends against use of HRT without a clear indication.
And from the RCOG web site:
- It is an effective treatment for hot flushes and low mood associated with the menopause.
- It can improve sexual desire and reduce vaginal dryness.
- It helps keep your bones strong by preventing osteoporosis.
Would taking HRT prevent dementia?
It is not known whether HRT affects the development of dementia.
And the NICE guidelines also comment on dementia
Dementia
It is currently unknown whether HRT affects the risk of developing dementia. NICE has recommended more research about this.
In conclusion, I think there are three areas that we really need to work on.
- The negative narrative around menopause
- Educating the public
- Educating our GP
Read More – the first paper from our menopause survey: An online survey of perimenopausal women to determine their attitudes and knowledge of the menopause
0 Comments