Hormone Replacement Therapy: Answers to the 10 most common questions
GP and menopause specialist Dr Louise Newson answers the 10 most common questions women ask about about Hormone Replacement Therapy (HRT).
1. Can a blood test tell if a woman is menopausal?
Current guidelines are clear that women who are over 45 years of age and have changing periods with menopausal symptoms do not need to have a blood test. This is because hormone blood tests fluctuate and can be very unreliable to diagnose perimenopause and menopause. Women who are between 40 and 45 years may benefit from a blood test and the recommendations are that women under the age of 40 should have at least two blood tests to confirm a raised FSH level. FSH is follicle-stimulating hormone which is elevated when women have low oestrogen levels.
2. When would you recommend a woman takes HRT?
Hormone Replacement Therapy is recommended often as a treatment option if women have symptoms related to their perimenopause or menopause that are having a negative impact on the quality of their life. Women do not necessarily need to have severe symptoms to benefit from taking HRT. The correct dose and type of HRT can improve many different symptoms related to changing hormone levels.
3. What are the main benefits of HRT?
There are numerous benefits of taking HRT. Many women find that their symptoms improve and the quality of life therefore increases. In addition, research has shown that taking HRT can reduce future risk of heart disease, osteoporosis, osteoarthritis, diabetes and dementia.
Since taking HRT I personally have found I have more energy, my sleep has vastly improved, my stamina and exercise regime are better, and my memory is thankfully much restored also.
4. What are the different ways to take HRT?
Oestrogen patches or gel through the skin is the safest way of having oestrogen because there is no risk of clot associated. Tablet oestrogen is associated with a small increased risk of clot. In addition, women who have digestive problems, diabetes, obesity or a history of clot can all have oestrogen through the skin whereas they are not recommended to have tablet oestrogen.
5. What are the risks of taking HRT?
The main concern women and healthcare professionals have regarding HRT is a risk of breast cancer. However, not all women who take HRT have an increased risk of breast cancer. If women who are under 51 (the average age of the menopause in the UK) and take HRT then they do not have an increased risk of breast cancer as they are simply taking hormones to replace the ones the body would otherwise be producing.
If a woman has had a hysterectomy and takes HRT she does not have a higher risk of breast cancer. Women who take combined HRT over the age of 51 may have a small risk of breast cancer when taking HRT for more than five years but this small risk is less than the risk of breast cancer in women who drink moderate amounts of alcohol, are overweight or who do not exercise. In addition, there has never been a study which shows there is an increased risk of death from breast cancer in women who take HRT. One in eight women who take HRT will develop breast cancer as one in eight women who do not take HRT also develop breast cancer.
6. Do you gain weight on HRT?
Many women who take the right type of HRT find that they lose weight, often because their lifestyle really improved. Women who gain weight in the short term do so usually because of fluid retention related to taking an older type of progestogen. It’s very unlikely that women put on weight due to HRT. Many women do put on weight during the perimenopause and menopause because of metabolic changes that occur in their bodies at this time.
Having a healthy, balanced diet and taking regular exercise is essential for every woman whether she’s menopausal or not. In addition, finding time for ourselves to improve our mental health and well-being is essential.
7. Are they any side effects?
Most women find that they do not develop side effects from HRT. Some women who have tablet oestrogen find that they can have nausea. Having older types of progestogens can cause some side effects such as fluid retention, moodiness and skin changes but these usually improve with having body identical HRT.
8. How long can you be on HRT?
Guidelines are very clear that there is no maximum length of time a woman can take HRT. Taking HRT is an individualised choice which needs to be reviewed every year. My oldest patient who takes HRT is 92!
9. Do menopause symptoms return once you stop taking HRT?
Some women find that their menopausal symptoms return when they stop taking HRT. This is because for some women menopausal symptoms can last for years, even decades. As women can take HRT in the long term, then taking HRT is not delaying the inevitable.
10. What is Bioidentical Hormone Replacement Therapy (BHRT) and is it available from your GP?
Bioidentical hormone replacement therapy is not licensed or regulated. These are compounded products that are made. There is no evidence that they are more beneficial or safer than body identical HRT which is available on the NHS. All the HRT that I prescribe in my clinic is licensed and regulated.
The problem with bioidentical HRT is that it is not known exactly what is in the medication and sometimes potentially harmful hormones are given to women. There are no current menopause guidelines that recommend the use of bioidentical HRT. Body identical HRT has the same molecular structures hormones we produce ourselves and is safer.
Our readers put some specific questions to Dr Newson:
Q. I started HRT 4 years ago aged 43. I started at 1mg Elleste which didn’t stop my symptoms so my GP upped the dose to 2 mg. I’m still waking up through the night soaking in sweat and getting such bad headaches that can last for 2 or 3 days and nights. If they aren’t helping my symptoms should I just not take them. I still have the depo injection every 12 weeks.
A. You are likely to benefit from having a different preparation of oestrogen, probably a patch or gel. Even though you have the depot injection you still need to have a progesterone to protect the lining of the womb using oestrogen.
Q. Can Vagifem cause irregular heartbeat?
A. Vagifem is a local oestrogen that is used vaginally so is not systemically absorbed. It is therefore not usually related to causing an irregular heartbeat.
Q. I’ve been on evorel and utrogestin since I was 45, I’m now 50 still perimenopausal, do I need to stop using HRT? I’ve tried reducing my dose from 50 to 25 but the unpleasant side effects return.
A. Many women continue to take HRT for many years and there is no maximum length of time for taking HRT. You do not need to reduce your HRT and certainly if you do decide to stop it then you would actually have an increased risk of heart disease and osteoporosis which are currently reduced by taking HRT.
About the Author
Dr Louise Newson worked as a GP in a large practice near Solihull, West Midlands for 15 years, as well as a medical writer and editor, having written hundreds of articles on various topics for both doctors, patients and organisations including the Royal College of General Practitioners (RCGP), MIMS Learning, www.patient.info and the British Journal of Family Medicine. You can find out more about the work Louise does at her website: https://www.menopausedoctor.co.uk/