Hormone Replacement Therapy has had a bad rap.

It has been headline news, linked to breast cancer, high blood pressure, and blood clots.

As a result, I believe some medical advisers have tended to over-estimate its risks and underestimate its benefits.

Unfortunately, this has meant many menopausal women not being in a position to make informed decisions, and to have suffered in silence.

It’s time to have a rethink. 

In this article we will look at the pros and cons of HRT, as well as explaining some of the different types available, and how to go about discussing HRT with your GP.

Hormone replacement therapy (HRT) is a medical treatment that uses hormones to help alleviate symptoms of menopause or other hormone-related conditions.  

By replacing the hormones (mainly oestrogen and progesterone) that the ovaries no longer produce in sufficient quantities, HRT was designed to help perimenopausal and menopausal women manage the symptoms associated with hormonal decline such as hot flashes, mood swings, bladder changes, irregular periods and more.

HRT Pros:

• Relief from Menopausal Symptoms: As mentioned above, hormone therapy can help alleviate symptoms such as hot flashes, night sweats, and vaginal dryness, making it easier for women to cope with menopause. 
• Improved Bone Health: Hormone therapy can help prevent bone loss and reduce the risk of osteoporosis. 
• Reduced Risk of Colorectal Cancer: Long-term use of hormone therapy may reduce the risk of colorectal cancer. 
• Lower Risk of Fractures: Hormone therapy can reduce the risk of fractures in women with osteoporosis. 

HRT Cons: 

• Increased risk of certain cancers: Hormone therapy has been associated with an increased risk of breast cancer, ovarian cancer, and endometrial cancer. 
• Increased risk of blood clots and stroke: HRT has been linked to an increased risk of blood clots and stroke, especially in women who have other risk factors for these conditions. 
• HRT can cause a variety of other side effects, including nausea, bloating, breast tenderness, and headaches. 
• Not suitable for everyone: Hormone therapy may not be appropriate for women who have a history of breast cancer, blood clots, or stroke, or who have certain medical conditions such as liver disease. 

Who Can Take HRT?

It is important to discuss HRT with a healthcare provider to determine if it is the right treatment option. 

Certain individuals might find they require further medications or that HRT is not recommended.

For example, a woman with a medical history of depression may need antidepressants alongside HRT. Interestingly, research has shown that HRT together with CBT, are effective against hormone dependent mood changes in women aged between 40 and 60.

For survivors of cancer, there are more detailed conversations needed with a doctor before thinking about taking HRT. It all depends on the type of cancer but any kind of hormone-dependent cancer requires extra caution.

For more information on the relationship between HRT and cancer,  Avrum Bluming has written a book ‘Estrogen Matters’.

Different Kinds of HRT

Sussex GP, Dr Katie Armstrong, who works mainly with menopausal and perimenopausal women, talked about her views in a recent interview. I’ll share some of the ideas discussed: 

Body-Identical HRT consists of plant based hormones, usually made from yam. Their chemical structure is almost identical to hormones made by the ovaries. This means your body recognises them and is better able to utilise and tolerate them, compared to synthetic hormones. 

Body identical oestradiol is administered in the form of a gel, patch or spray directly onto the skin. It is a small molecule which can be absorbed easily and it travels straight into the bloodstream. This mimics the journey of natural oestrogen and is therefore considered safer. It is uncertain how much hormone each woman is actually getting because of differing absorption rates of skin.  So Katie recommends having a hormone blood test if you only get a partial response after being on HRT for 3 months. 

Synthetic-HRT uses lab-made hormones similar to those made by the ovaries. However these can have some adverse effects on the body compared to natural hormones. Additionally, synthetic HRT is usually taken as a pill. Katie warns that taking HRT orally has the potential to put your health at risk. When oestrogen first goes through the gut and gets processed by the liver the process itself can activate clotting factors. This could potentially lead to an increased risk of DVT (deep vein thrombosis), brain clots and high blood pressure. 

Bio-identical HRT is a mixture of different natural hormones compounded together based on a woman’s individual blood or saliva hormone tests. They are made by specialist small pharmacists and are used mainly by private clinics.  One potential downside is that they often use additives, which can be harmful to some women. In addition tests to determine bespoke hormone levels for individual women may not be very accurate. NICE (National Institute for Clinical Excellence)  does not approve of bioidentical hormones. It is unlikely that your NHS doctor would prescribe these. 

Discussing HRT With Your GP

 To make the most of your appointment with your GP, I recommend preparing for this by thinking about some of the following:

• Try to be clear as to why you might want to take HRT. Is it to alleviate symptoms, or for longer term health benefits such as prevention of osteoporosis or heart disease? 
• Try to find out if there is a doctor in your GP practice responsible for, or with specialist knowledge about, menopause and ask to see them. 
• Arrive prepared with some information. Green climactic scale is a quick symptom checker questionnaire that you can complete and even email through before your appointment. This can help the doctor prepare in which direction to take the conversation. 

A couple of extra points to note:

• There is no evidence to support the use of antidepressants for hormone dependent mood changes, according to NICE
• If the doctor would like more information on some of these ideas, especially about body identical HRT, then Newsonhealth.co.uk have a number of fact sheets that can help doctors prescribe body identical HRT. 

Your Body, Your Choice

I am not offering any opinion here as to whether or not you should start to take HRT. The decision is, of course, purely yours. 

The difficulty we face is the overall lack of understanding about menopause and women’s bodies in general and disappointingly in the medical profession. 

Hopefully this post will help you feel more  knowledgeable and confident about any future conversation with your doctor.

Perimenopause and menopause constitute a huge change for all women and they can impact on your confidence, health and overall quality of life.

Whether you decide on HRT or not,  I can’t emphasise enough how important it is to support yourself through this period of change with proper nutrition and positive lifestyle habits.

If you would like a chat about any of this, please click below and book a call. 

If you enjoyed this article, you may also enjoy Understanding Perimenopause. Blood Tests, GPs  or Reasons To Consider Hiring a Coach.