Hormone Replacement Therapy (HRT) – Better Health Channel

Menopause is the final period and occurs because a woman stops ovulating, her ovaries no longer produce oestrogen (one of the female sex hormones) and her monthly period (menstruation) ceases. It is a natural event that marks the end of the reproductive years, just as the first menstrual period during puberty marks the start.

Many women, although not all, experience uncomfortable symptoms during and after menopause, including hot flushes, night sweats, sleep disturbance and vaginal dryness. These symptoms and physical changes can be managed in various ways, including lifestyle changes like healthier eating and increased exercise, and by hormone replacement therapy (HRT).

While HRT reduces the likelihood of some debilitating diseases such as osteoporosis, colorectal (bowel) cancer and heart disease, it may increase the chances of developing a blood clot (when given in tablet form) or breast cancer (when some types are used long-term).

For women who experience menopause before the age of 45 (early or premature menopause), HRT is strongly recommended until the average age of menopause onset (around 51 years), unless there is a particular reason for a woman not to take it.

There is no evidence to suggest that a woman with a family history of breast cancer will have an added increased risk of developing breast cancer if she uses HRT. The risk with combined oestrogen and progestogen is greater than with oestrogen alone or with newer HRT agents such as tibolone (sold as Livial) and may also depend on the type of progestogen used.

Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch. Similarly, tibolone increases the risk of stroke in women in their 60s and older.

Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more, and may have no increase in risk if treated with low doses by mouth or through the skin. It is not recommended to commence HRT in women over 60.

Limited research to date suggests the increased risk of clots is mainly related to combined oestrogen and progestogen in oral (tablet) form. Some studies suggest a lower risk with non-oral therapy (patches, implants or gels).

Most studies do not show a link between weight gain and HRT use. If a woman is prone to weight gain during her middle years, she will do so whether or not she uses HRT. Some women may experience symptoms at the start of treatment, including bloating and breast fullness, which may be misinterpreted as weight gain. These symptoms usually disappear once the therapy doses are changed to suit each woman.

No alternative therapy has yet been clinically proven to reduce a menopausal womans risk of osteoporosis. Some of the more popular alternative therapies include soy products, phytoestrogens and herbal medicines.

Women with liver disease, migraine headaches, epilepsy, diabetes, gall bladder disease, fibroids, endometriosis or hypertension (high blood pressure) need special consideration before being prescribed HRT, which may be given through the skin (transdermal) in many cases.

Despite the risks of long-term use, in women with severe and persistent menopausal symptoms, HRT may be the only effective therapy. Women with early or premature menopause may be prescribed HRT long-term, as their risks for heart disease and osteoporosis are higher than a woman who undergoes menopause around the age of 50 years. Seek specialist advice from a menopause clinic or menopause specialist. Regular check-ups are recommended.

Evidence has not conclusively shown that HRT will increase the risk of breast cancer recurring in a woman with a prior history of the disease. However, oestrogen and progestogens (forms of progesterone) may stimulate some types of cells in the breast and increase the risk of breast cancer in women without a history of breast cancer.

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Hormone Replacement Therapy (HRT) - Better Health Channel