Making the Most of Menopause

‘Doctor, won’t you please tell me – should I take HRT?’ There is no correct answer. It depends on your individual situation.

Significant research on the benefits and drawbacks of hormone therapy has been conducted worldwide. Unfortunately, it mostly resulted in misinformation. Although there were some unexpected findings, the results were not nearly as dramatic as portrayed.

I remember medical school gynecological lectures back in the mid ’90s. I recall the professor’s emphatic words: ‘Unless contraindicated, HRT is mandatory for all menopausal women.’ This meant that unless you had a medical reason not to go onto HRT, you should be encouraged to go on it. It made perfect sense. HRT keeps your bones strong, alleviates the symptoms of menopause and the scientific consensus was that it had a protective effect on the heart and prevented certain cancers.

Menopause is a process that can begin from two to 10 years before your last period and the symptoms may continue for upwards of five years. Symptoms include hot flushes, night sweats, irritability, depression, foggy head, insomnia, painful intercourse and urinary incontinence. Menopause is a deficiency or total absence of oestrogen. This hormone is vital in maintaining tissue elasticity and strength. Declining levels cause wrinkles as you age and thinning of tissues and muscles in the vagina and urinary tract.

A deficiency of oestrogen is associated with memory loss, irritability, depression and fatigue, all due to its effect on receptors in the brain and on nerve proteins, such as serotonin. Although menopause can be uncomfortable, the guidelines regarding HRT discretionary use have changed considerably following two extremely significant studies: the Women’s Health Initiative (WHI) and the Million Woman study.

The WHI revealed that long-term use of HRT (in excess of five years) was associated with an increased risk of breast cancer, clots, heart attack and stroke. However, the increase in risk is very slight. For every 10 000 women taking HRT, 38 would develop breast cancer, while for every 10 000 women not taking HRT, 30 would develop breast cancer. And for every 10 000 women taking HRT, 37 would have a heart attack while for every 10 000 not taking, 30 would have a heart attack.

What was most significant is not the very slight risk increase, but the fact that HRT doesn’t protect against heart disease and stroke. The Million Woman study also revealed a slightly increased risk in breast cancer and the seven-year HERS (Heart Oestrogen Replacement Study) study showed no benefit of HRT to the heart.

HRT contains either oestrogen alone (if you no longer have your uterus) or oestrogen with progesterone, if your uterus is intact. HRT is available either in oral tablets, transdermal patches or creams.

The current recommendations from international menopausal societies is that you shouldn’t take HRT if you have had breast cancer or have a strong family history, if you have had clots, a stroke and possibly heart attacks (although this requires further study).

If you have none of these contraindications and you are suffering a difficult menopause or are at high risk for osteoporosis, use HRT in the lowest effective dose for a period of only five years.

You also have the option of choosing to treat each individual symptom separately. There is fairly effective medication for hot flushes, depression, specific osteoporosis management and vaginal oestrogen cream for vaginal dryness and thinning. You could also consider some of the alternate homeopathic remedies, although none of them have stood up to scientific scrutiny.

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