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Hormone replacement therapy for menopause symptoms

Aug. 21, 2019


Hormone Replacement Therapy (HRT) for Menopause Symptoms

There is a lot of information out there about menopause, how women can manage the symptoms and the safety of hormone replacement therapy (HRT). There has been a lot of controversy about whether or not taking hormones is safe and many women resort to unproven or natural/bioidentical alternatives because of these concerns. What we know now is that generally the benefits of HRT outweigh the risks and can greatly improve the quality of life for many women. So could this be an option for you?

What is menopause?

Menopause is defined by the last monthly menstrual period and usually occurs between the ages of 40 and 55 years. This is when ovulation stops which means the levels of oestrogen and progesterone decreases. The menopausal transition is the time leading up to the menopause when women start to have changes in the menstrual cycle e.g. irregular periods or changes in flow. During this time, the levels of these hormones fluctuate and it is these rises and falls that cause the symptoms of menopause.

Symptoms of Menopause

The symptoms of menopause can last for 5-10 years before women have their last period but there is no way to predict when they will start or how long they last. The frequency and severity of these symptoms vary significantly between women.

Physical symptoms

Common physical symptoms include hot flushes, night sweats, aches and pains, vaginal dryness, reduced libido, urinary frequency and sleeping difficulties

Psychological symptoms

The changing hormones and sleep deprivation can contribute to mood changes, anxiety, irritability, forgetfulness and difficulty concentrating or making decisions (some describe this as "brain fog").

Managing symptoms

Many women find that symptoms are not too bothersome but around 60% of women will have mild symptoms for around 4-8 years. Around 20% will have no symptoms and another 20% will be severely affected. Being informed about what might happen during this time is a good start! Often mild symptoms can be managed with a few lifestyle modifications and if it is more severe, medication can also be used.

Lifestyle

Having healthy lifestyle habits improve wellbeing and positivity. Being low in oestrogen increases the chance of weight gain so eating well with a reduction in portion sizes can help with maintaining a healthy weight. Exercising regularly helps with bone health, is preventative for diabetes, depression, heart disease and dementia and it has also been shown to decrease the frequency of hot flushes. Quitting smoking is also always a good idea!

Other strategies to reduce or manage hot flushes include:

Hormone Replacement Therapy (HRT)

We now know that in most circumstances, it is very safe to use HRT. However. In the past few decades there has been a lot of controversy which meant many women have missed out on the benefits and improvement in quality of life that it can provide. The reason for this controversy was mainly down to a large study from 2002 called the Women's Health Initiative (WHI) which looked at HRT in relation to cancer, heart disease and fractures. The researchers felt that the risks outweighed the benefits so stopped the study early. The main risks they were concerned about was related mainly to combination oral oestrogen and progesterone which may increase the risk of breast cancer and heart disease. As a result of the WHI many doctors and their patients stopped using HRT. However, when we look back and review the study, the women in the WHI study were in their mid-sixties (not recently post-menopausal) and often overweight which doesn't represent the majority of women for whom HRT would be suitable (usually around the age of 45-55 years). Many further studies have been done since the WHI which show that if women start HRT around the time of menopause the risk is actually very small, about 0.5% for a 50 year old women and 1% for a 60 year old woman.

As well as helping to relieve the symptoms of menopause, HRT is also beneficial for long term bone health and it actually has a protective effect on heart disease when used in younger women within 10 years of menopause. There is some evidence to suggest that HRT used early in the post-menopausal years decreases the risk of dementia in later life but more research is needed in this area.

Of course as with anything, it is important to weigh up the benefits and risks of HRT with a knowledgeable health professional who can consider the symptoms, age, years since menopause and general health. There are many options available from tablets, to a small skin patch the size of your fingernail which you change twice a week or vaginally to help with the vaginal symptoms. If you think that HRT might be an option for you, book an appointment with your doctor to explore these options. You don't have to suffer!

Other techniques

If HRT is not for you then there are also other options available to relieve symptoms. These include anti-depressants, gabapentin (a pain medication) and clonidine (a blood pressure medication) which have all been shown to decrease hot flushes.

Some women find that herbal or alternative therapies might be helpful but most have not been studied or shown to be effective or safe. Some such as black cohosh (Remifem) have been associated with serious side effects like liver disease. Others include evening primrose oil, ginseng or wild yam which have no data on safety or effectiveness for menopausal symptoms. Bioidentical hormones are another recently popular option marketed as "natural" but there are a number of concerns regarding their safety which we explore in another article which can be found out [insert URL].

Feeling positive about menopause

Menopause is a time where women may experience physical and emotional changes and it is very individual to each person. Many women may be at a stage of their lives where they are juggling roles as mothers of teenagers, caring for elderly parents and maintaining a work-life balance. Some "me time" is important to keep balanced and menopause can be seen as a fresh start. It's a good time to assess your lifestyle, health and make a commitment to stay well and healthy in the mature years.

For more information about menopause, the Australasian Menopause Society has a great page on frequently asked questions about Menopause at https://www.menopause.org.au/hp/gp-hp-resources/695-responding-to-frequently-asked-questions


Article by Angela Sun, 5th year medical student currently on placement at Medplus