Now that I am planning to start offering private consultations and management of menopause, including HRT prescriptions, I thought it might be useful to give a brief overview of HRT: what it is, how it is used, why it is used and what is it’s safety profile to help women judge whether this might be the thing they need to help with bothersome (and in some cases, devastating) symptoms or peri-menopause and menopause.
Is HRT safe to use?
The decision to use hormone replacement therapy (HRT) is an important one. It can help relieve symptoms of menopause, but it can also cause serious side effects. So, is HRT safe to use?
The answer to this question depends on a variety of factors, including your age, overall health, certain medical conditions and the type of HRT you are considering. To make an informed decision, it is important to understand the potential risks, benefits and types of HRT.
In this blog post, I hope to explore the safety of HRT, the types of HRT available, and the potential risks and benefits of using your chosen HRT. We will also discuss the importance of talking to your doctor about HRT.
1. What is HRT?
HRT is a medication that is used to treat the many symptoms of menopause. It works by replacing the hormones that the body stops producing at the onset of peri-menopause; oestrogen, progesterone, and testosterone. This medication helps with maintaining a woman’s overall health (cardiovascular, reproductive tract, urinary tract and mental health) as well as symptomatic relief of menopausal and peri-menopausal symptoms.
2. Types of HRT available
There are several types of HRT available, including oral pills, vaginal pills (pessaries), patches, gels, sprays, injections, intra-uterine devices (IUS, Marina etc) and implants. Each form of HRT has its own set of risks and benefits, so it is important to talk to your doctor about which is right for you. For women with a uterus (womb), it is important to note that HRT must include progesterone as well as the oestrogen component to protect against endometrial cancers. Testosterone remains controversial within the medical community in the treatment of HRT although there are many evidence-based studies coming up from reliable sources and published within the BMS (British Menopause Society) confirming the importance of the role of testosterone and its use within in HRT for managing things such as energy levels, vaginal health and managing recurrent UTIs (urinary tract infections); so not just sex drive!
3. Potential Risks and Benefits of HRT
HRT can help reduce the major symptoms of menopause; including hot flushes (or flashes if you are feeling American), night sweats, and vaginal dryness. And also the lesser discussed symptoms such as brain fog, reduced energy levels, libido and dry skin. It can also help reduce the risk of osteoporosis and cardiovascular (heart) disease. However, there are also potential risks associated with HRT, including a small increased risk of stroke, blood clots, and breast cancer – we will come to this bit later on in this blog and I will eventually write a more concise blog discussing this topic at a later date.
4. Talking to Your Doctor
It is important to talk to your doctor about the risks and benefits of HRT relating to you, specifically, before starting treatment. Things like a medical history of clotting problems, obesity, smoking status or a family history of certain breast cancers can increase your risk of adverse events. Your doctor can help you make an informed decision about whether or not HRT is the best choice for you and also talk you through alternative measures you can take.
Questions to consider asking your GP when discussing HRT:
- with my medical history, would HRT be a sensible option for me?
- what are the risks and benefits to me if I took HRT to treat my symptoms?
- how would HRT help me with my symptoms, what are the benefits to me?
- what alternatives to HRT are there?
- what would be the best dose to start on? Is this the lowest dose?
- what forms of HRT might be best for me and how do I start?
**The risks of HRT with regards to breast cancer have been heavily played up over the years and whilst, yes, HRT can increase the overall risk of breast cancer if used for 5 years or more, the overall benefit is considered to far outweigh the risk of taking it. In women using unopposed oestrogen (oestrogen only), there is fact a decrease in the risk of breast cancer! As I said before, I will do a blog discussing risks of breast cancers, HRT and other lifestyle risks that affect a women’s risk of developing breast cancer in her lifetime**
5. Conclusion
HRT can be a safe and effective treatment for menopausal symptoms. However, it is important to understand the potential risks and benefits as they relate to you, before starting HRT. Talk to your doctor and discuss the potential risks and benefits in your own case, to make an informed decision about whether or not HRT is right for you. HRT is nothing to be afraid of anymore and there is a lot of evidence that lifelong HRT is the way forwards. I know what my choice will be when my time comes, do you?
Keywords: Hormone Replacement Therapy, HRT, Menopause, Risks, Benefits, menopause, peri-menopause, British Menopause Society, risks, evidence from BMS
