What are the benefits of HRT?
The main benefit of HRT is to relieve the symptoms of menopause [insert link to symptoms]. For most women, these benefits significantly outweigh the risks associated with HRT. Alongside helping with hot flushes, night sweats, mood swings and bladder symptoms, the following are benefits of HRT:
- The effect of HRT on bone health is significant. HRT increases bone density, and the benefits are maintained many years after stopping HRT.
- In women with premature menopause [Premature Ovarian Insufficiency (POI)], the use of HRT is recommended as the long term lack of estrogen in a younger age group can increase the risk of developing osteoporosis, cardiovascular disease and cognitive problems. These problems can be reduced with HRT as long as is used at least until the average age of menopause (51 years).
What are the risks of HRT?
Over the past 20 years, there have been a number of studies into the risks of taking various forms of HRT. The risks can vary from one woman to another and can depend on many factors, so it is essential that any treatment is determined on an individualised basis taking into account familial and personal health history. Guidance from the menopause societies and the National Institute for Health and Care Excellence is that the lowest effective dose is used. The duration of use should be individualised and re evaluated annually according to the benefit / risk balance.
Breast, endometrial and ovarian cancers are multi-factorial and may involve general health risk factors, such as diet, smoking, alcohol intake and family history. The data concerning risks are complex and vary according to the population studied. Consequently, these risks should be discussed in detail within a menopause clinic to establish the absolute risk for each individual.
Continuous combined HRT appears to reduce the risk of endometrial cancer. The risk of breast cancer does not appear to increase within the first 5 years of usage of HRT and if present, is no greater than 1 extra case per 1000 women per year. The risk ovarian cancer with HRT remains controversial but if present, is no more than 1 extra case per 5000 women per year.
There are no scientific data that show an increased risk of cervical, vaginal and vulval cancer with HRT usage and HRT appears safe after diagnosis of these cancers.
Oral HRT appears to be associated with an increase in risk of developing a clot, medically known as a Venous Thrombo Embolism (VTE).This risk also increases with age. Therefore long term use needs to be assessed in line with any other clotting risk factors.
Transdermal HRT avoids stimulating clotting factors and can potentially be used with caution even in women with a clotting risk.
The pros and cons of HRT should be carefully weighed up in high risk situations and it may be prudent to work with a haematologist who has knowledge of HRT.
What are the side effects of HRT?
This depends on what has been prescribed, but the most common side effects are:
Estrogen: bloating, breast tenderness or swelling, nausea, headaches.
Progesterone: weight gain, fluid retention and swelling (oedema), fatigue, acne, drowsiness or insomnia, breast discomfort or enlargement, premenstrual syndrome (PMS)-like symptoms.
The Hormone Health clinic will try and achieve the best hormone balance possible, which may mean altering the doses/timings of elements of the treatments. Progesterone seems to be the most common cause of unwanted side effects but for instance, using the capsules as a vaginal pessary instead of taking orally, can reduce the side effects significantly.
Who can take HRT?
HRT is particularly recommended for women below the age of 60 years. This represents the group of women, where any risks are at their lowest and possible benefits are most likely. Women over 60 years wishing to start HRT should have the benefit risk balance carefully considered with low dose transdermal estrogen preferred with natural progesterone.
HRT should be used in women with Premature Ovarian Insufficiency (POI) or early menopause at least until the age of 51 to protect against osteoporosis, cardiovascular disease and dementia.
Usual contra indications to HRT include:
- Undiagnosed abnormal vaginal bleeding
- Active or recent blood clot or myocardial infarction (heart attack)
- Suspected or active breast or endometrial (womb) cancer
- Active liver disease with abnormal liver function tests.