Hormone Replacement Therapy (HRT): The Low Down
HRT - you've no doubt heard about it and you probably know it's what women nearing menopause might take to manage their symptoms.
But let's dig deeper into exactly what it is and when you might need to consider it.
What is HRT?
HRT stands for Hormone Replacement Therapy.
Nowadays doctors prescribe a very different type of HRT than they did in the 60s, using bioidentical hormones: known as BHRT.
BHRT is derived from plant sources that are molecularly identical to the hormones your body naturally produces. BHRT replaces some of the hormones we start to lose as we age.
The hormones being replaced are estrogen and progesterone.
BHRT come sin pills, creams, gels, patches and pellets which can be placed under the skin. Pellets can last for months, so you don’t have to remember to do something daily.
It’s important to note that anything absorbed through the skin doesn’t have to go through the liver, so you avoid any side effects of clotting.
What does HRT do?
HRT will help relieve symptoms of perimenopause and menopause. Symptoms like
- Hot flushes
- Night sweats
- Irregular periods
- Problems with falling asleep, staying asleep and sleep quality
- Breast tenderness
- Itchy/crawly/dry skin
- Exhaustion
- Trouble concentrating
- Vaginal dryness
- Loss of libido
- Migraines
- More intense PMS
- Mood changes - anxiety, depression, rage
- Weight gain, despite no changes to diet or exercise, due to the metabolism slowing down or insulin resistance.
When should I take HRT?
There is no right or wrong answer here. Remember everyone’s experience of perimenopause and menopause is going to be totally different. Some women might not experience any symptoms and there will be women who experience all the symptoms and everything in between.
It will also depend on the severity of your symptoms and how much it’s impacting on your day to day life and how much you are willing to live with.
For some women natural support might be enough, or you may find a combination of both works well for you.
Perimenopause can vary a great deal in length for each woman. Anything from 2-12 years but on average is between 4-6 years. The average age to reach menopause is 51 years of age. So most women hit perimenopause (transition years) in their 40’s. In the early stages of perimenopause you will have wild and fluctuating estrogen and low levels of progesterone.
As you get nearer menopause (a point in time when you haven't had a period for 12-months) and early menopause you will have low levels of estrogen.
You might find in the early stages of perimenopause you don’t need HRT but as you get nearer to menopause and in the first few years of menopause HRT could be helpful as your body adjusts to the low levels of estrogen.
I Heard HRT Gives You Cancer: What About That?
Ah yes, great question! Let's talk about the study that scared everyone for decades and the TV show you have to watch...
The Women’s Health initiative hormone therapy trial in 2002, reported that HRT, specifically the combination of estrogen and progestin together, increased the risk for blood clots, stroke, breast cancer and heart attacks.
The reporting of this study had a significant impact on women coming off of HRT. Note that it was based on the old style of synthetic hormones and the women in the trial where 65 and past perimenopausal and early menopause stage.
“Additional research over the past 10 years, has found shown that the level of risk with HRT depends on the individual woman, her health history, age, and the number of years since her menopause began. It is women below the age 60 years and recently started menopause, who are at a lower risk when taking low doses of HRT compared with women over 60.”1
Researchers suggest that breast cancer appearing in HRT patients already had the cancer cells, and that the HRT might accelerate it.
If you have a family history of breast cancer, you might want to discuss the pros and cons of HRT with your GP.
The TV Show You Have to Watch
Davina McCall presented a UK TV show called: 'Sex, Myths and the Menopause' which goes in depth about the 2002 study and unravels the myths and stigma around HRT. We recommend watching it, you can watch it here.
When Might I Need Progesterone?
If you are taking BHRT oestrogen and you have a uterus your doctor is likely to prescribe progesterone to protect your uterus. When oestrogen is given alone it can stimulate the growth of the lining of the uterus and increase the risk of endometrial cancer.
Who Can Prescribe HRT?
Your GP or gynecologist should be always your first port of call.
If you don’t have a GP who feel understands women’s health and has a firm grasp on perimenopause and menopause, we recommend checking out this registry with the Australasian Menopause Society, of doctors who have a special interest in perimenopause and menopause.
Things To Think About When Considering HRT?
- Do I need oestrogen plus progesterone or just progesterone?
- What are my symptoms? Are they because of low or fluctuating oestrogen? Or low progesterone?
- What stage of perimenopause are you in? (Read more about the stages here) The stage you're in will affect the hormones you will need to take.
- What is your current health like? Are there lifestyle changes that could improve symptoms?
- Is there family medical history to consider?
- What are your preferences in the different forms of HRT available?
Sources
https://www.veryperisummit.com.au Talk from Dr Yasmin Tan
Hormone Repair Manual, Lara Briden