Menopause and Hormone Replacement Therapy – Your Questions Answered.

Menopause is when periods stop for good and do not reoccur for the rest of ones life. It is important to note that menopause is not an illness but is a very natural and normal part of every woman’s life. Unfortunately menopause can be associated with symptoms that may cause distress and discomfort to women around the world. These symptoms can also persist for a number of years. However there are treatments available and one of these is known as hormone replacement therapy (HRT). Many will have heard about this therapy and may know that its use is controversial. This article aims to teach you about HRT and the risks and benefits associated with it.

What happens in the menopause?

As one gets closer to menopause, your body begins to make less of two important reproductive hormones known as estrogen and progesterone. These hormones are responsible for a number of reproductive functions including controlling a woman’s periods. The closer to menopause you get the more likely it is that you will notice more irregularity in your periods. They may be lighter or heavier, last longer or for only a few days. Some of the symptoms that women suffer from when they go through menopause include hot flushes, a dry and itchy vagina, decreased desire for sex, trouble with sleeping, weight gain, feelings of depression and painful sexual intercourse. Some of these symptoms are caused by the decreased levels of hormones but others are caused by lifestyles stressors and anxiety associated with menopause. Not everyone requires treatment as some people find that the symptoms hardly bother them at all, but other women fond the symptoms very distressing. If the above list of symptoms are bothering you and you think they may be related to menopause then you should see your doctor and ask about treatments.

What is HRT?

As mentioned earlier HRT stands for hormone replacement therapy. This is a medical treatment that contains one of the hormones that your body no longer makes a good amount of, estrogen. The goal of this treatment is to replace some of the estrogen that the body stops making when you reach menopause. Symptoms that are specifically related to a lack of estrogen are vaginal dryness and hot flushes. With HRT most women take a combination of both estrogen and progesterone. It is shown that adding progesterone reduces the risk of getting endometrial cancer of the womb that has an increased risk in women taking estrogen alone. This type of HRT is called not surprisingly combined HRT. In women who have already had their womb removed (hysterectomy) do not need to take a progesterone as they do not have a womb to get cancer in. HRT can be taken in such a way so that you can still have a period every month. This is known as cyclical HRT and is often prescribed for women who are still have periods but are suffering from menopausal symptoms. Alternatively you can take HRT everyday without taking breaks, which is known as continuous HRT and is more appropriate in women who have not had periods for a year or longer. HRT can be taken via a tablet, skin patch, an implant, a gel, or a vaginal ring or cream. Some products are more appropriate for different symptoms and you and your doctor can talk about which one will work best.

How can it help?

HRT tablets will decrease the number of hot flushes that a women experiences after about three weeks of use. Some of the other forms of HRT may also reduce the number of hot flushes but comparisons have not been doe for this symptom. What is known is that women who have the worst symptoms will get the most benefit from treatment. It has also been shown that high doses of estrogen are most effective in reducing the number of hot flushes. Vaginal dryness can be relieved with a tablet, cream, or a patch. As a result of taking this medication for dryness most couples find that sex becomes less painful as a result. Relief from this symptom can be achieved with only a small dose of the estrogen. Creams with estrogen in them and estrogen vagina tablets (pessaries) are most effective at reducing urinary infections. Also taking HRT is likely to make you feel less depressed, although it may not help women with severe depression. HRT can also help you to sleep a bit better and some studies say that HRT improves overall wellbeing, although this is not proven fro sure. HRT reduces your risk of getting weak bones, a condition known as osteoporosis.

Can it be harmful?

Unfortunately all good things are not without their trade offs and HRT is no exception. There are risks associated with taking HRT and for this reason benefits must be weighed up against risks. Most women only have a very small risk of adverse effects but you should still discuss these with your doctor. Doctors are advised that the smallest effective dose should be prescribed to women who are to be tried on HRT. They are also told only to keep women on HRT for as long as necessary. The risks associated with HRT are outlined below although it is important to note that most studies refer to combined HRT (with both estrogen and progesterone). With most of the creams and tablets that are available to be put into your vagina, doctors think that the side effects are less because less of the hormone gets into your blood supply. Taking combined HRT has been shown in one big study to slightly increase your chance of getting breast cancer. This risk is a little bit higher in women who take HRT over the age of 60. If you use HRT for a long period of time then your risk will be higher than those who use it for short periods of time. Five years after stopping the HRT your risk of breast cancer goes back to that of the normal population. There is also evidence that women who take HRT are more likely to get blood clots than women who don’t take it, although this risk is very small for most women. Now having clots in your bloodstream is bad news because they can get stuck in smaller blood vessels and cause them to get blocked up. This means that blood cannot get to some organs. The risk of getting a blood clot in your lungs is two times that of the general population. If you have had blood clots in the past be sure to mention this to your doctor, as you will be at further increased risk. Also women who take HRT are at slightly higher risk of having a stroke. Women over the age of 60 and take HRT more than ten years after going through menopause have a small increased risk of heart disease. There was a recent study that found that HRT might slightly increase your risk of ovarian cancer. Fortunately this increased risk of ovarian cancer seems to disappear when one stops using HRT. Taking HRT for a year or more may increase your risk of gallbladder disease (gallstones) or urinary incontinence. There are some other side effects that you can get when you start HRT but these usually disappear after a few months of treatment. Often a change of HRT product helps control the symptoms. The side effects that one may encounter include unexpected bleeding, tender breasts, headaches and mood swings. Women may find that they gain some weight when they first try HRT, however after a few months this should correct itself and no long-term weight gain is expected.

What are the alternatives?

Tibolone is an additional form of hormone treatment, which does not contain estrogen or progesterone. This medication does not affect the lining of your womb and so if you start taking it at least one year following your periods ending, you should not get any monthly periods. Those on Tibolone are likely to have half as many hot flushes, improved sexual satisfaction, more sexual arousal and less vaginal dryness. Sex drive is said to increase in women who take Tibolone compared with combined HRT. Tibolone may increase ones risk of breast cancer, but is still less than if you take combined HRT. The most common side effect of note is spotting and bleeding from the vagina. Unfortunately researchers have found that good cholesterol levels (HDL) can fall by around a third on those taking Tibolone. Phyto-estrogens are a type of chemicals that are found in various plants. These can be said to act like a rare form of estrogen and soya products such as tofu and miso are rich in these chemicals. Other things that are rich in these are beans, lentils, celery and certain fruits. Over the counter supplements such as red clover pills can be purchased. The research for these is not as good as HRT. Phyto-estrogens are most effective in reducing the symptoms of hot flushes and not so good at combating vaginal symptoms. There are other treatments that have been tried for HRT, however the evidence is not complete for these treatments. Some of these include clonidine (this is a medication that is used for high blood pressure), antidepressants may also show some merit and testosterone (the male hormone) may also be effective. More research is required to know whether or not these treatments are effective and one should always consult their doctor before starting on any of these.