Do you think ALL menopausal women should take HRT?

One thing for sure is that women go through the menopause. There is so much negativity around the menopause, but my view is that post menopause, life can reach new heights as we are released from our periods, menstrual cycle mood swings, and the need for contraception. But some feel that the two main hormones that decrease during and after the menopause, progesterone and oestrogen, should be given to all women as hormone replacement therapy (HRT) until the day they die.  What do you think?

It is very difficult to obtain accurate figures on how many women have severe menopause symptoms but it would seem that the majority do not need any treatment as they can tolerate the transient physical and emotional symptoms. And it is important to remember that once the menopause has finished, symptoms normally stop.

To relieve symptoms, women can make diet and lifestyle changes, such as cutting out tea, coffee, stopping smoking and cutting down on alcohol. Women should take precautions to keep cool. Some will feel a benefit from doing exercise, especially weight bearing exercise and aerobic activity to keep our body and heart fit and also eating a healthy diet high in food for strong bones to reduce the risk of osteoporosis.

But there is no doubt that some women will need medical care to relieve their symptoms and the most common treatment is HRT. HRT can completely get rid of hot flashes, vaginal dryness and many other menopause symptoms.  There is evidence that it protects against osteoporosis and can reduce the risk of urinary tract infections. HRT contains estrogen often combined with progestogen (combined HRT).  If you take estrogen on its own, it can increase your chance of getting endometrial cancer so this is only used on its own if you have had your womb removed (hysterectomy).  HRT can be given as a tablet, patch, implant, or cream in a similar way to contraceptives.  Some women say it increases their wellbeing but the opposite is also reported.

HRT was first prescribed for the menopause in the 1940’s but did not become popular until the 1960’s. Research into the use of HRT and long term consequences is confusing and contradictory.  In 2002 and 2003,  two large studies were reported that raised concerns over the use of HRT.  One study was a clinical randomised trial in the USA (Women’s Health Initiative (WHI)) and the other was an observational questionnaire study in the UK (the Million Women Study (MWS)).   There were two main concerns: 1) the extended use of HRT may increase the risk of breast cancer and 2) the use of HRT may increase the risk of heart disease.  After these reports, the number of women taking HRT dropped by 66%.  But then a study from Denmark in 2012 demonstrated that healthy women taking HRT for 10 years immediately after the menopause had a reduced risk of heart disease and of dying from heart disease.

The interpretation of the long term effects of HRT and risks are still being debated. As well as heart disease – for other diseases we are seeing contradictory studies.

Women experience higher levels of dementia than men. This is something that I am concerned about as many female members of my family have had dementia. In all the research I have read and talks I have been to, the evidence is totally conflicting. There is some animal experimental and observational evidence that oestrogen is good for the brain but no robust prospective trials which prove this. A few clinical studies have looked at long term outcomes of HRT but they show conflicting results; HRT reducing or increasing the risk. In 2019 there were a study showing that HRT caused a slight increased Alzheimers. On the UK Alzheimers Society web site they say “Until there is better evidence, the potential benefits of HRT as a way to reduce the risk of Alzheimer’s disease do not outweigh the potential risks of HRT, which includes an increased risk of certain types of cancer, heart disease and stroke.”

HRT can also cause side effects including breast tenderness, headache, nausea, indigestion, abdominal (tummy) pain, mood swings and vaginal bleeding.  The disadvantages of prolonged use are that it may increase the risk of blood clots, stroke, heart disease and breast cancer.  There is one study that suggests HRT increases the risk of ovarian cancer but this association disappears if HRT is stopped. I know a few women who have recently tried HRT but found the side effects too much. One close friend had a deep vein thrombosis within 2 months of taking HRT.

The North American Menopause Society, the American Society for Reproductive Medicine, and The Endocrine Society have recently produced a position statement on the use of HRT.  They say “most healthy, recently menopausal women can use hormone therapy for relief of their symptoms of hot flashes and vaginal dryness if they so choose”. They go on to say that “these medical organizations also agree that women should know the facts about hormone therapy.”  It is not recommended that HRT is used for more than 5 years because of the risks.

Women considering taking HRT need to carefully discuss the risks and benefits with their doctor.  They need to consider their age, medical history, risk factors, if they previously had premenstrual syndrome and personal preferences.  The lowest dose should be used and how long treatment is continued must be discussed.  Women need to be annually followed up with their doctor.  It is important to be up to date with the latest research.

What is your view on HRT? Should all women take HRT and if so, just till they get through the menopause or forever?

Read More:

Women’s Health Concern – HRT benefits and risks.

British Menopause Society – HRT

Global women – osteoporosis; a key issue after the menopause

Global women – risks of hormone replacement therapy for the menopause is still debated

Global women – do you think hormonal contraceptives and HRT increase mood swings?

Image credit – www.amoils.com