When it comes to perimenopause, I always say it requires a multi factorial approach, where you need a number of tools in your kit to help manage your symptoms. Diet and lifestyle changes are one of the tools, another one is HRT (Hormone Replacement Therapy).
Understanding Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) is a medical treatment used to relieve symptoms of perimenopause and menopause in women. Over the years, HRT has been a subject of debate and misinformation, leading to confusion and misunderstandings. This section is not about me telling you to take HRT, it is for informational purposes only. If you want to explore the possibility of taking HRT it is important to discuss this with your GP.
What is HRT?
HRT involves the use of hormones, typically oestrogen and progesterone, to replace the declining levels in a woman's body during menopause. Oestrogen is responsible for regulating the menstrual cycle and maintaining bone health, while progesterone helps protect the uterus. HRT comes in various forms, including pills, patches, creams, and gels.
Body identical hormones
There is a wide variety of HRT available so it can be confusing when you research the different types. You may have heard of body identical, bioidentical or compounded but what exactly are they and what is the difference? Body identical HRT that is prescribed by the NHS is the safest and most regulated type of HRT. This includes oestrogen in the form of a tablet, patch, gel or spray and micronised progesterone. Body identical hormones are made from the yam plant and has the same structure as the hormones that are produced by your ovaries. This form of HRT is thoroughly regulated, tested and research and is recommended by the National Institute of Health and Care Excellence (NICE) guidelines.
Bioidentical and compounded HRT
These types of hormones are not regulated and do not undergo the same quality controls as body identical HRT. They are not licensed or regulated and therefore they are not recommended. Efficacy and Benefits of HRT HRT is effective in alleviating menopausal symptoms. Research shows that it significantly reduces hot flashes, night sweats, and vaginal dryness. It can also help improve mood and sleep quality in some women. Furthermore, HRT is effective in preventing osteoporosis, a condition where bones become weak and brittle.
Safety Concerns and Breast Cancer
There have been concerns regarding the link between HRT and breast cancer. These concerns come from a study that was published in 2002 by the Women’s Health Initiative. After it was published many doctors stopped prescribing HRT and women also stopped taking it.
However, in 2023 the WHI rescinded certain statements:
Then: “HRT increased the risk of breast cancer” |
Now: “After almost 20 years of follow up, they now report that oestrogen alone decreased the risk of breast cancer, decreased the risk of death from breast cancer and decreases the risk of death from all causes.” |
Then: “HRT did not have a clinically meaningful effect on health-related quality of life for women in menopause.” |
Now: They have subsequently reported that HRT is the most effective treatment for managing menopausal vasomotor symptoms.” |
Then: “HRT increased the risks of cardiac events, strokes, and cognitive decline and that it even increased ‘ALL CAUSE MORTALITY’.” |
Now: “Those conclusions have been rescinded as well, especially when HRT is initiated within 10 years of a women’s final menstrual period.” |
It is also important to note that this study had limitations. For example, a majority of the study participants were more than 10 years past their final period and they used old style HRT which are synthetic hormones and not body identical hormones that are used today.
What are the risks associated with taking HRT?
Many women are concerned about breast cancer when taking HRT, particularly if there is a history of breast cancer in your family. There is a small risk associated with taking oestrogen and a synthetic progesterone, but the risk is small and, factors such as your age and general health are important. Taking body identical progesterone (micronised progesterone)e has not been shown to be associated with an increased risk of breast cancer.
The risks associated with taking HRT depend on the type you take along with other factors such as your age and your health. For most women, the benefits of taking HRT outweigh the risks. This is why it is important for you to have a discussion with your GP.
Hormone Replacement Therapy (HRT) is an effective treatment for perimenopausal and menopausal symptoms and offers several benefits, including relief from hot flushes, improved bone health, and potential cardiovascular benefits. While there are some safety concerns, such as a slight increase in the risk of breast cancer, the absolute risk remains low for most women. It is crucial to have open discussions with your GP to assess your individual needs so your get the right preparation and strength for you needs as well as having a discussion about the risks and benefits so you can make informed decisions about HRT.
If you would like to make an appointment to see your GP and discuss your options for HRT, I recommend that you download my free eBook, How to Talk To Your GP About Your Perimenopause Symptoms So They Will Take You Seriously.