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The Menopause Exchange Blog

HRT MYTHS

HRT is the most effective treatment for menopausal symptoms such as hot flushes, night sweats and vaginal dryness. Its use plummeted towards the beginning of this century, following some large clinical trials that suggested using HRT increased the risk of stroke, cardiovascular disease and breast cancer. But over the past decade, further research and reanalysis of the data have revealed that for most women under 60, the benefits of HRT outweigh any risks. However, myths prevail regarding HRT use. This article looks at the research behind HRT to dispel some of these common myths.

This article was included in issue 78 (autumn 2018) of The Menopause Exchange newsletter.

HRT causes weight gain
There’s no evidence to support a direct link between HRT and weight gain. Women may gain weight in the middle years due to changes in their diet, physical activity and lifestyle. A slowing metabolic rate and redistribution of women’s body fat may also contribute to this. A healthy diet and regular exercise are important to prevent weight gain. Some women experience side effects of bloating and fluid retention on HRT, which can lead them to believe that they’re putting on weight.

If you’re using HRT, you can’t get pregnant
HRT isn’t a contraceptive and women can get pregnant while using it. Most national guidelines recommend that women taking HRT who wish to avoid unwanted pregnancy continue to use some form of contraception until age 55, when a loss of natural fertility can be assumed.

HRT delays the menopause
HRT replaces the hormone/hormones that are no longer produced in your body. But it does nothing to delay the decline in ovarian function. If women experience menopausal symptoms after stopping HRT, these are symptoms they would have experienced anyway if they had never had HRT. In fact, when coming off HRT, it’s advisable to reduce the dose gradually to avoid oestrogen ‘withdrawal’ symptoms. Any symptoms, if these occur, are usually temporary and decrease quickly.

HRT carries the same risks as the contraceptive pill
Although the contraceptive pill and HRT both contain oestrogen and progesterone, the hormones in HRT are less potent and in lower doses, resulting in differences in side effects and risk profiles. Most contraceptive pills contain a synthetic oestrogen compound – ethinyl oestradiol combined with synthetic progesterone, (usually a derivative of testosterone). Most HRT products combine natural oestrogen (17 beta oestradiol) with either a synthetic or natural progesterone. HRT isn’t contraindicated in women who suffer from migraines (patches or gels are preferred) and transdermal (across the skin). HRT has a much lower risk of blood clots than oral pill products.

Natural products taken to ease menopausal symptoms are safer than HRT
Many women choose to take ‘natural’ or ‘bio-identical’ products to treat their menopausal symptoms. But these terms can be misleading or confusing. Many HRT compound products sold under these categories have often been custom-made by the individuals or clinics prescribing them and therefore they haven’t been subjected to the same level of rigorous scientific testing as conventional HRT products.

HRT can’t be prescribed until a woman stops her periods and her symptoms are unbearable
Many women have bad menopausal symptoms long before their last period (during the perimenopause) and HRT can be safely prescribed to ease their symptoms. HRT can also help if women have mild menopausal symptoms. In addition, there’s increasing evidence that the earlier women start using HRT, the more the HRT protects them against osteoporosis and heart disease.

Women need to have multiple tests and examinations to make sure they can take or need HRT
Most women don’t need any specific tests before HRT is prescribed. For some women, tests such as blood hormone profile, thrombophilia (abnormal blood clotting) screen or pelvic ultrasound may be needed but this will depend on their medical history. It’s recommended that a woman’s blood pressure is monitored regularly while she’s taking HRT.

Vaginal oestrogen has the same risks as oral or patch HRT
Topical oestrogen as a vaginal tablet, cream or ring is very effective at treating vaginal dryness and painful sex during the menopause. Vaginal oestrogens don’t have the same risks associated with them as systemic (oral or patch) HRT. This is because these products restore oestrogen only in the vagina and surrounding tissues, such as the bladder, without giving oestrogen to the rest of the body. These vaginal products can be safely used by most women and can also be used on a regular basis over a long period of time (usually indefinitely) as the vaginal symptoms may return if they stop using the treatment.

You can only take HRT for five years
HRT may be taken for as long as necessary at the lowest effective dose if the benefits of treatment outweigh the risks for that particular woman. For younger women, HRT is recommended until the age of the natural menopause (usually 51) for symptom relief as well as bone and cardiovascular protection. For women over 50, most will need HRT for about four to five years when their menopausal symptoms are most severe. Most women will be able to come off HRT by the time they reach 60. Few women with persistent menopausal symptoms may need to keep using HRT beyond this age. Each woman should be assessed individually for how long they need to take HRT and an annual clinical review of risks versus benefits should take place as long as they continue to use HRT.

About the author
Mr Vikram Talaulikar is Associate Specialist at the Reproductive Medicine Unit at University College London Hospital.

Created Autumn 2018

Copyright © The Menopause Exchange 2019

References

  1. Menopause: diagnosis and management, NICE guideline, The National Institute for Health and Care Excellence, UK. Published: 12 November 2015; nice.org.uk/guidance/ng23.
  2. Contraception for Women Aged Over 40 Years, FSRH guideline, Faculty of Sexual & Reproductive Healthcare, UK. Published: August 2017 (Updated October 2017); https://www.fsrh.org/standards-and-guidance/documents/fsrhguidance- contraception-for-women-aged-over-40-years-2017.

 

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