Breaking down the taboo of HRT

“HRT usage has risen by a third as more celebrities speak out about the menopause and campaign for better care”
– Kate Foster – Scottish Health Editor

All women who reach a certain age will begin to hit menopause. Of these, 75% will experience symptoms from the well-known hot flushes to others like weight gain, low libido, mood swings, insomnia, aches, and pains.

Hormone Replacement Therapy (HRT) provides women with hormones – Oestrogen and Progesterone – that are lost during the menopausal transition to alleviate these symptoms.

Mainstream media and celebrities alike speak out about HRT for good reason. However, there are many controversial myths and lots of misinformation out there.

Celebrities including Davina McCall, Penny Lancaster and Lorraine Kelly have opened up about their personal troubles with the menopause and the benefits of HRT, “breaking down the taboo that has long kept the topic of the menopause out of the headlines.

With a nationwide increase in demand, linked to a nationwide shortage , HRT has broken through into the mainstream and is becoming a more popular option for women going through the menopause. The issue has also made to the headlines due to manufacturing issues and supply chain issues – resulting in national shortage.

The vigorous debate continues… however let us address some of the myths and get back to the basics: What is HRT? Is it safe? How does it work? How do you purchase it? What do you need to know about it?

What is HRT?

HRT is a Hormone Replacement Therapy most commonly employed to relieve symptoms of the menopause. The treatment aims to replace hormones that naturally degrade as you approach the menopause.

There are two main types of hormone treatments:

Oestrogen only
Combination HRT (which is a combination of oestrogen and progestogen).- the most common treatment/solution for most women

What are the associated risks?

It is important to understand the risks of HRT but also, understand the benefits so a balanced decision based on risk v reward can be made.

Like many medical treatments, there are some risks associated. Blood clots and strokes (with oral therapy), as well as cardiovascular disease (a larger risk for women over the age of 60) are all dangers according to the NICE Guidelines.

A major concern for many is the associated risk of earlier HRT treatments and cancer. However, there are many additional factors to consider when looking at this risk including: obesity, smoking and not being physically active as well as the treatment itself.

As the understanding of hormones, and their derived treatments have grown, so too has the safety of HRT. New HRT formulations that have benefited from medical advancement now comes with a much-reduced risk.

“The risks are usually very small, and depend on the type of HRT you take, how long you take it and your own health risks.” NHS Benefits and Risks of HRT

What was once considered an option for many as ‘too risky’ is now a much more attractive proposition due to the benefits HRT brings.

Benefits of HRT

The benefits of HRT at the various stages of Menopause are well documented and can relieve most menopausal symptoms such as:

Bone thinning (most common after Menopause)
Hot flushes
Night sweats
Irregular sleep patterns
Mood swings
Vaginal dryness
Reduced sex drive

But there is more to HRT than just a treatment for Menopause. More specifically Oestrogen.

Oestrogen is an amazing hormone that can help reduce the appearance of fine lines and wrinkles on the skin. It can also promote hair growth, which can contribute to a more youthful appearance.

Oestrogen is associated with qualities such as regulation of the menstrual cycle, physical changes, and sexual libido. But it controls so much more.

It affects:

Hyaluronic Acid Production
Skin thickness, elasticity, and ability to hydrate
Hair thickness
Nail strength
Increases to Metabolism level
Improves Muscle mass
Energy level improvements

All the above contribute to feeling healthier and manifesting a much more positive outlook.

How does it work?

HRT can be taken in numerous forms:

Tablets – taken by mouth. Both types are available in tablet form and is often most convenient for many women.
Patches – placed on the skin. Both types are available, placed on the skin and replaced every few days.
Topical Oestrogen Gels – which is applied to the skin and absorbed. Not available currently as a combination with Progestogen taken separately.
Vaginal Gels – applied internally to alleviate vaginal dryness
Oestrogen spray – applied to the forearm

Where can I get it?

You can get HRT through the NHS or a private clinic, if based in the UK. At present, all treatment types require a prescription from your doctor.

HRT comes in many types, combinations, doses, and applications. The patient would need the most appropriate prescription through expert consultation.

What does a typical treatment look like?

Treatments for HRT vary. Those that address menopause are based on where you are in the menopausal transition (perimenopause, menopause, post menopause).

There are two types of treatments: cyclical (or sequential) and continuous (or non-sequential).

Cyclical treatments for perimenopausal women on combined HRT, is advised and is divided into two categories:

Monthly: taking oestrogen every day, while taking progestogen during the last days of the menstrual cycle
Every Three Months: taking oestrogen every day, whilst taking progestogen alongside for 14 days every three months (recommended for women who experience irregular periods).

Alternatively, for postmenopausal and menopausal women, a continuous approach is recommended. This should be taken continually, with oestrogen and progestogen given every day.

What are the common myths associated?

Leading Menopause Expert Dr Louise Newson reveals there to be many misconceptions, or myths, surrounding HRT which most women believe to be true.

Myth #1 – You must stop taking HRT after 5 years
There is no minimum or maximum length of time for which you can take HRT. This is a tailored treatment, and the length of time you wish to use it for depends on your health, symptoms, and personal preferences.
Myth #2 – HRT delays your menopause
If you have menopausal symptoms after your HRT, this means you would still be having symptoms even if you had never taken HRT.
Myth #3 – You can only take HRT once your period has stopped
You do not have to wait for your period to stop after starting HRT. The menopause if officially 12 months after your last period. But during perimenopause you can still suffer from menopausal symptoms whilst still having a period due to the fluctuating hormones. The best advice is do not wait until the symptoms become unmanageable. Women who start taking HRT within ten years of their menopause believe the health benefits are superior.
Myth #4 HRT can cause weight gain
Many women believe taking HRT will make them put on weight, but there is no evidence that this is the case. You may gain some weight during the menopause, but this often happens whether you take HRT or not.

Can Menopausal Symptoms return if you stop?

A report from the Women’s Health Initiative (WHI) found that more than half of the women who reported hot flushes, night sweats and other related menopausal symptoms at the time of starting HRT, experienced a recurrence of these symptoms after being taken off the therapy.

As a result of this, it is advised to come off HRT gradually. The body becomes dependent of the additional supply of hormones, therefore a sudden halt of the treatment may in-fact cause an ‘overnight menopause.’ Despite this, NHS guidance advises that you can stop suddenly or gradually and can all depend on the individual whether symptoms come back.

How long should you take HRT?

There is no ‘right time’ to come off the therapy treatment, however the answer is dependent on several factors.

What age you began the treatment
What the main reasons were for starting
Your general health and fitness
Medical history and lifestyle

“One in ten UK women who would stand to benefit from HRT are actually taking it” – DR. Louise Newson – Healthista Writer

It is important to acknowledge that the benefits of retaining oestrogen can outweigh the reported risk factors. It is important to consider HRT to:

Maintain bone density to avoid injuries and long-term mobility issues
Increase levels of collagen boosts connective tissue and skin tone
Maintain a strong mental and emotional state of mind, allowing for a better quality of life
Uphold healthy cardiovascular system, essential to pursuing an active and stress busting lifestyle

With the benefits to your patient’s emotional and physical well-being PLUS considering the the reduced risks, ‘One out of ten UK women’ seems a much too small adoption of a therapy that can have life changing impact.