Hormone replacement therapy and menopause management

Hormone replacement therapy (HRT) has received increased media attention over the past couple of weeks. Many find that it can be difficult to make sense of what the research around HRT is telling us. How does it work, what are the benefits and, importantly, what are the risks that come with HRT?

HRT is the medical replacement of the female hormones oestrogen, progesterone and sometimes testosterone. Progesterone is only needed for women who still have their uterus (womb). HRT is used to manage some of the symptoms associated with menopause such as hot flushes, night sweats and vaginal dryness, especially if these symptoms are interfering with daily life. Other treatments are available for the treatment of menopause symptoms, however, the following is just a discussion of HRT.

How does it work?

The symptoms associated with menopause – commonly hot flushes, night sweats, sleep disturbance and vaginal dryness – are typically caused by lowered levels of oestrogen in the body. By using HRT, for a period of time, these symptoms can be helped. While there are many ways to treat the hot flushes associated with menopause, research indicates that no treatment is as effective as oestrogen replacement therapy where appropriate.

The benefits of HRT

For those who are suffering from the symptoms associated with menopause, HRT can provide significant relief. Some women find taking HRT helps with their overall quality of life; they sleep better, have more energy and can think more clearly.

The risks of HRT

There have been many studies that have investigated the links between HRT use and an increased risk of cancer and other illnesses. Research indicates that for the majority of healthy women, HRT is a safe and effective treatment for the relief of menopause symptoms. There are, however, some women who are at risk of cancer and other illnesses if they take HRT, including those who:

• Have previously been diagnosed with breast or endometrial cancer
• Are at high risk of breast or endometrial cancer
• Have previously been diagnosed with cardiovascular disease or blood clots in the veins
• Are at high risk of cardiovascular disease or blood clots in the veins

A recent study published in the medical journal The Lancet suggested that women who are taking HRT for the treatment of menopause symptoms have a slightly increased risk of developing ovarian cancer. This study pulled together data from a range of papers about the use of HRT, however, upon close analysis of the paper’s findings, the results show that there is an increase of one case of ovarian cancer per 2000 users of HRT after five years of use.

Professor Rod Baber, President of the International Menopause Society, says “My advice to women using HRT would be that this study suggests a very small increase in risk [of ovarian cancer] with use of HRT, that this is no reason for them to stop taking their HRT, that the benefits of HRT in their own individual cases should be weighed up against this information and that they should discuss this with their own doctor”.

Is HRT right for you?

It is important to take a balanced, evidence-based and informed approach to health and all the risks and benefits of HRT should be considered before it is used. Current evidence suggests that the benefits of HRT, for many women, far outweigh the risks and that women taking HRT for the relief of menopause symptoms report a greater quality of life. The decision to take HRT should be based on your individual circumstances, lifestyle and medical history. A dedicated women’s health practitioner, with expertise in HRT prescription, is the best person to guide you and go through the pros and cons of HRT and other treatments for menopause related symptoms.

Find out more information about the benefits and risks of HRT.