Healthy Menopause: How safe is HRT?

Liz writes:

Going through the menopause is a natural part of life for most woman and symptoms range in severity from almost none (for the lucky few) to raging hot flushes, pelvic problems, emotional flare-ups and sleepless nights. So how safe and helpful is hormone replacement therapy (HRT) and should we all be taking replacing our hormones to improve our menopausal wellbeing?

What is Hormone Replacement Therapy?

The concept of replacing lost or declining hormones has been around since the late 1800s, but HRT has come on a long way since its original use of bovine ovarian tissue (extracted from cows) and pregnant horse’s urine (popular in America). Today, the vast majority of the commonly prescribed UK and European HRT formulations are plant-derived and come from the oestrogen-rich yam plant. These hormones include oestrogen and progesterone (to boost naturally declining supplies) and occasionally testosterone too (yes, women do produce testosterone and this decreases in later life, alongside oestrogen and progesterone). Not only can replacing these lost hormones improve a range of menopausal symptoms, but HRT has also been shown to lower the risk of heart disease and osteoporosis. It’s the most effective, clinically proven treatment there is for relieving symptoms such as hot flushes, night sweats, joint pains, mood swings and urinary incontinence, and for the vast majority of those under 60 years old, overall the benefits of HRT would definitely seem to outweigh the risks.

Should I be taking Hormone Replacement Therapy?

The elephant in the room during the menopause is often ‘should I take HRT to help my menopausal symptoms?’. Most symptoms of the menopause are due to fluctuating (and then low, or no) levels of the hormone oestrogen. All types of HRT contain an oestrogen hormone and this is what replaces the body’s natural supplies. Other hormones that may be taken as part of HRT are testosterone and progesterone (in the form of progestogen). The doses and types of hormones very much vary according to your own personal medical history, symptoms and need, so it’s important to discuss your symptoms in detail with your GP and, if necessary, get a second opinion from a doctor who specialises in this area. The good news is that even low levels of HRT taken temporarily can be of significant benefit and may dramatically improve your day-to-day wellbeing.

What’s best for me?

It’s easy to feel confused about the different types of HRT, as well as about the benefits and risks of taking it, so it’s very important that your own individual health is taken into consideration by your doctor here. HRT brings many benefits, including the treatment of vaginal dryness (which can lead to urinary tract infections), depression and loss of libido. Other positives are HRT’s ability to increase bone density and the protection of discs in the spine.

Ways of taking Hormone Replacement Therapy

HRT is taken as tablets, skin patches or gel – or as a combination of these. As the hormones in skin patches and gels are absorbed through the skin, they’re sometimes a better option to pills that are processed via the liver. As the skin is so protective, it’s hard for substances to get through, but HRT skin patches and gels are made in a different way from everyday skincare. The patches work by forming an occlusive sticking plaster-like barrier over the skin, keeping the hormone loaded onto the patch and in direct contact with the skin 24/7. The gels are normally made with the emulsifier triethanolamine, an ingredient unusually compatible with both oils and water, making it more easily absorbed into the body through the skin. One or two pumps of oestrogen-rich gel are usually applied each night. Tablets are relatively straightforward to take and it’s often handier to take the progestogen tablets, such as Utrogestan, last thing at night as they can make you feel slightly sleepy (a helpful side-effect at bedtime!). Your doctor may also suggest having a Mirena coil (IUD) fitted to release small amounts of progesterone internally. This is especially convenient as it stays in place for several years without a further thought.

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