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HRT

HRT for menopausal symptoms

Encountering menopause in middle age be a challenging time for many women.

The body undergoes changes that may leave you feeling anxious, depressed, and lacking in confidence.

And that’s not to mention the uncomfortable physical symptoms from hot flushes to putting on weight around your midriff.

Many women are not aware that there’s lots that can be done to help you through the menopause and improve your health and wellbeing with the use of HRT.

What are the symptoms of menopause?

Some women are lucky enough to sail through this transition time free with few symptoms, but for a many they are all too familiar.

Menopause happens as your ovaries gradually produce less oestrogen, causing menstrual cycles to shorten, and eventually stop.  The symptoms are linked to withdrawal from having less of these hormones, and although they should pass after a few years, they can hamper your quality of life. They include:

What is HRT?

HRT refers to the menopause treatment where women’s depleting hormones – oestrogen and progesterone – are boosted with synthetic equivalents, or bio-identical hormones.  The term ‘bio-identical hormones’ refers to treatments which use identical molecules to ones our body produces.

There are many different types of HRT, and it’s a matter of finding the one that’s right for you.

Most women take a combination of oestrogen and progestogen – a synthetic version of the hormone progesterone, such as, norethisterone, dydrogesterone, medroxyprogesterone and levonorgestrel.

If you’ve had a hysterectomy, you can be prescribed solely oestrogen, such oestradiol, estrone and estriol.

You can still get pregnant whilst taking HRT, and the NHS recommend you keep using contraception until two years after your last period if you’re under 50 or for one year after the age of 50.

What are risks of HRT?

Although HRT was freely prescribed in the 80s and early 90s, preliminary results from studies such as the Women’s Health Initiative showed that those on HRT had an increased incidence of stroke, breast cancer and blood clots. However, a recent review of this long-term study allayed fears. The study, which followed 27,000 women over two decades, concluded that any risks were off-set by the protective health benefits of taking HRT, and that it was safe so women shouldn’t miss out on being offered it.

Who shouldn’t take HRT?

A consultation with a gynaecologist who is an expert in menopause is to be advised for any women who is considering HRT. They will take a full and complete medical history and advise you whether HRT is suitable for you, and what kind is best.

  • HRT is usually contra-indicated if:
  • Undiagnosed abnormal vaginal bleeding
  • If there is any concern about breast or endometrial cancer
  • Heart issues such as thromboembolic disorder or acute-phase myocardial infarction
  • Liver disease with abnormal liver function tests
  • The condition porphyria cutanea tarda
  • If there is any suspicion of pregnancy

When should you start taking HRT?

You can start taking HRT as soon as the symptoms start to show, and you feel they are impacting on your life. Tests aren’t necessary, but your GP may send you for a blood test (to measure the level of your Follicle Stimulating Hormones (FSH), as an indicator of how menopausal you are.

Perimenopause usually begins in your 40s but doctors are seeing more women with symptoms of menopause earlier, thought to be due to us being more exposed chemicals in food preservatives and sprays and creams we use on ourselves, and in our homes. These Endocrine Disrupting Chemicals mimic hormones

Symptoms of menopause usually intensify the nearer you get to menopause (the average age for menopause is 51), an indication you’re close is not having a period for three months, and a year without a period signals the start of menopause.

HRT tends to be most effective when taken by women under 60 or within 10 years after menopause has begun, in terms of relief of menopause symptoms and also for preventing osteoporosis-related fractures. You can take HRT for as long as needed, but most women usually stop after a few years when symptoms stop.

How do you take HRT?

It’s available on prescription from your GP either in tablet form, or as a skin patch, an implant under the skin, or a gel that’s applied to the skin, as well as vaginal creams and pessaries.

You can take HRT continuously without a break, or in cycles where you take oestrogen continuously and add in progestogen every few weeks.

It’s common to begin with a low dose, which can be increased later on. You’ll need to give it a few weeks before you’ll notice whether the treatment is working. Usually you’ll trial it for three months, and if it’s not working, your GP will change your dose or suggest another form of HRT. There may be side effects such as breast tenderness, indigestion, tummy ache, nausea or vaginal bleeding. But these should disappear.

What are the health benefits of HRT?

Every woman is individual, and while HRT isn’t recommended for everyone, your GP will help you to assess whether it’s suitable for you. However, more doctors are agreeing that it is the most effective way of treating menopause.

This was confirmed when a number of professional bodies, from the International Menopause Society to the American Society of Reproductive Medicine, released a collective statement which said there was good case for HRT to be the first line of therapy in treating menopause.

They stated that HRT, when correctly prescribed, is associated with:

  • Fewer fractures
  • Less colon cancer
  • Fewer heart attacks (oestrogen protects the heart)
  • Possibly less breast cancer
  • Fewer deaths (research finds that women taking HRT in their 50s are 31% less likely to die than those who don’t take it.)
  • HRT and bone health
  • Women lose bone mass much more quickly in the years immediately after menopause than they do at any other time in their lives. The drop in bone density is caused by falling levels of the female hormone oestrogen. Oestrogen helps to protect bone strength.

While statistics suggests women who started their periods earlier than normal, or who used oral contraceptives that contained oestrogen, may have higher levels in their body, most women can lose up to 20% of their bone density in the five to seven years after the menopause.

Although you can take moves to ensure you have a healthy lifestyle to boost your bone density, such as a vitamin D rich diet, sunshine and weight-bearing exercise like weights, running and walking, HRT may help protect you against osteoporosis and bone fractures in later life. At Twenty-five Harley Street we measure and monitor bone health using the most advanced DEXA (DXA) scanning technique, combined with a unique Bone Marker Turnover testing service. This constitutes the “gold standard” in bone health assessment.

Alternatives to HRT

Bioidentical hormones

Bioidenticals are hormones with the same chemical structure as one’s naturally produced by your body. Many women say they find they suit them better, but there is less research to support them than conventional HRT. Bioidenticals are often from plant origin – for example, soy – but they still need to be processed in a lab, and manufactured into something absorbable by the body.

Exercise

Exercise can help as it produces feel-good endorphins which lift and stabalise your mood, as well as helping you to stay toned, and even walking builds bone density.

Food

Eating sugary foods causes huge swings in blood glucose triggering symptoms similar to menopause, compounding the problem, so following a balanced diet will make you feel physically and mentally well.

Miss Stephanie Moore, a clinical nutritionist specialises in nutritional medicine to balance hormones, recommends these foods to keep your blood sugar levels steady.

  • Good fats such as those found in salmon
  • Complex carbohydrates
  • Fresh vegetables and fruit to stay hydrated
  • Tofu, soya, red clover, alfalfa, flaxseed and dandelion all include phytoestrogens – weak plant oestrogens.
  • Reducing your intake of alcohol, caffeine and spicy foods

Exercise

Discover an exercise regime that suits you – this could include running or walking, which helps guard against osteoporosis, as well as releasing stress-busting hormones. Yoga can also help reduce stress further.

Herbs

If you cannot take HRT, you could consider certain herbal supplements such as Black Cohosh. for hot flushes or Dong Quai for menstrual problems. However, also go to a reputable practitioner or a gynaecologist who takes a natural approach to the menopause.