Hormone replacement therapy (HRT) has become very topical again lately.
Lots of improved, clearer information is now making the rounds to educate women and set the record straight when it comes to certain research out there that had cast HRT in an unfavourable light.
But how do you know which hormone replacement therapy will be the best for you? Read on to find out.
First, what is HRT?
As we all know, during perimenopause the oestrogen levels produced by our bodies fluctuates and this imbalance can cause many symptoms like hot flushes, night sweats, sleep problems, muscle and joint pains, mood changes, vaginal dryness and discomfort with sex.
Ultimately, menopause results in an oestrogen deficiency – and it’s permanent. These levels will not increase again – unless we start Hormone Replacement Therapy.
HRT is a hormone treatment that always includes oestrogen, often progestogen and sometimes testosterone. It replaces those depleted hormones and subsequently improves your menopausal symptoms.
Oestrogen
This replacement oestrogen comes in various forms – a pill, patch, gel or spray. The most common type of oestrogen used is estradiol which has the same molecular structure as the oestrogen that your body produces. It comes from the yam.
If you have a history of migraines, liver disease or blood clots, there is a small risk of clotting if you take the oestrogen pill because oral therapy is metabolized through the liver. And by processing estrogen, the liver increases the production of blood-clotting factors. It’s, therefore, preferable to use a patch, gel or spray because those do not pose that risk and would be safer to use.
Progestogen
If you still have a uterus, then you will need to take progestogen alongside the oestrogen (this is known as combined HRT). The reason for this is that oestrogen alone can overstimulate the cells lining the uterus causing the uterus lining to thicken which can result in an increased risk of uterine cancer. Taking progestogen keeps the lining thin, thereby avoiding the risk.
Testosterone
Women sometimes have testosterone prescribed to them if they still experience fatigue, brain fog and a lack of libido after taking oestrogen and progestogen.
How do I know I need HRT?
Basically, if you’re over 45 and are experiencing irregular periods and other menopausal symptoms which are negatively affecting your life – you are eligible. (I am not talking about early menopause here.) Obviously, you would need to consult with your doctor, discussing your age, symptoms, medical history etc. as to whether you can (or should) take HRT and which route would be best for you.
What are the benefits of HRT?
Your symptoms will improve. Hot flushes and night sweating usually stop within a few weeks of starting HRT. Also, there will be an improvement to your mood, focus, joint pain and overall appearance.
HRT helps to reduce recurrent urinary infections.
Taking oestrogen lowers the risk of osteoporosis because oestrogen helps to slow bone thinning and increases bone thickness.
Vaginal dryness and soreness should improve.
Your risk of cardiovascular disease will decrease. In other words, you will be less likely to have heart problems, a stroke or vascular dementia.
And your risk of other diseases like bowel cancer, osteoarthritis and depression could also decrease.
But what are the risks?
There are basically two small risks for women taking HRT – breast cancer and blood clots. This sounds pretty scary, but…
For women who only take oestrogen, there is no increased risk for breast cancer. And while taking combined HRT (oestrogen and synthetic progestogen) may cause an increased risk, some studies have shown that you can reduce this risk by taking micronised progesterone (derived from plants).
It’s worth noting that the risk is very low. Actually, obese women, women who don’t exercise and women who drink two glasses of wine a night have a higher risk of developing breast cancer than women on combined HRT.
And now that transdermal oestrogen (patches, gels and sprays) is available, the risk of clotting has been reduced as well. (Only the oestrogen pill was used initially. And it increased the risk of blood clotting because the liver increases the blood clotting factors being produced when processing the oestrogen pill.)
Women using HRT in patch or gel/cream form have not been found to be at increased risk for blood clots, even those taking higher doses of the medication.
People started worrying about the safety of HRT when journalists picked up on the small risks noted in the Women’s Health Initiative (WHI) study in 2002 and reported on them out of context and without consulting the scientists involved. Unfortunately, this misleading reporting and subsequent belief, has resulted in many women avoiding HRT, thinking that it’s dangerous. This has meant that many women have been missing out on the numerous benefits of HRT and have continued to suffer from symptoms over the years.
Listen to: Trying to right 20 years of misinformation about HRT
It’s also worth noting that for most women who start HRT before the age of 60, the benefits outweigh the risks.
Are there any side effects of HRT?
Side effects aren’t common, but breast tenderness, bleeding and leg cramps can occur in the first few months of starting HRT. These should subside as your body becomes accustomed to the hormones again.
When’s the best time to start HRT?
Menopausal women can start taking HRT at any age. However, it is most effective to start HRT during perimenopause. Women who start HRT within 10 years of their menopause (one year without a period) get the most out of the benefits of taking HRT.
How long can you safely take HRT?
You can basically take HRT forever. There is no maximum length of time that you should only take hormone replacement therapy for. They used to worry about the increased risks of breast cancer and blood clots when oestrogen only came in pill form. But now we have the option of patches, gels and sprays that work through the skin so we don’t have the risks that a pill would pose (increased risk of clotting as we get older). And we now have micronised progesterone which poses fewer risks than the synthetic version.
So which HRT will be the best for you?
Ultimately this depends on many factors. Make an appointment with your GP and discuss your options and what will work best for you.
Oestrogen – pill, patch, gel or spray, depending on various needs and conditions.
Progestogen – yes, if you still have your uterus. And reduce your risk of breast cancer by taking a micronised progesterone. Or no, if you’ve had a hysterectomy.
Testosterone – if symptoms persist even after taking oestrogen and progestogen.
Dosage would need to be discussed with your doctor and might need to be changed until you find the perfect dosage for you.
In conclusion
I hope you’ve found this information helpful. As I’ve mentioned before, I found a fantastic midlife resource in Dr Louise Newson. When doing this research, I drew a lot of information from her website, podcasts and Instagram. I would highly recommend following her to find out more about many different topics relevant to our midlife journeys.
Are you on HRT? Or thinking about starting? I’d love to hear your thoughts about hormone replacement therapy.
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Feature photo: Photo by Ava Sol on Unsplash
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