Menopause, the run up (perimenopause) and life after (post menopause) can make the lives of many women miserable causing a loss of confidence, depression and anxiety, lack of energy and libido. These effects can devastate the woman, her family and intimate relationships.
Menopause & HRT
What is the real story with the menopause and HRT? I thought it increased my chances of breast cancer?
In 2002 there was a study called the Women’s Health Initiative that was published that appeared to show that there was an increased risk of breast cancer and heart disease associated with taking HRT. This led to many people stopping HRT and a lot of women were indeed too frightened to take HRT in the future.
However this study was re-examined in 2017 and re-published and true analysis revealed that there was no statistically significant increased risk of breast cancer associated with the type of HRT taken by the patients in the study at that time.
It is generally accepted that oestrogens abolish menopausal symptoms, increase bone density, reduce the incidence of heart attacks, strokes and Alzheimer’s disease and improve sexuality.
Oestrogen users also live about 1.5 years longer than non-users.
With that being the case, acceptance of oestrogen therapy should be simple but it is not. Only about 15% of women at risk take oestrogens and the vast majority abandon HRT within a year. This lack of continuity is due to a combination of things including breast cancer, fear of weight gain, reluctance to have periods or the PMS type symptoms that occur with cyclical progestogen.
Oestrogen replacement can be started in the over 60’s and can be beneficial. We know that it has to be transdermal however not oral oestrogen when started over sixty and we know transdermal oestrogen will do no harm and can help symptoms.
Additionally there is a belief that older osteoporotic bones do not respond to oestrogens. They do and they respond even better than the bones of younger postmenopausal women. In fact the lower the bone density the greater the increase with hormone therapy.
Similarly, HRT for the peri-menopausal woman who are still having periods but suffering from depression, tiredness and loss of libido is another neglected area. These patients often have a long past history of hormone related depression i.e. postnatal depression or premenstrual depression. Such patients suffer their worst depression in the one or two years before their periods stop but often need oestrogens instead of, or as well as, antidepressant therapy.
When should I expect the Menopause?
The menopause is defined as 1 year from your last period.On average women will start to go through the natural menopause in their late 40’s/early 50’s. The average age of the menopause being 51 years old in the UK. Sometimes menopause can happen prematurely, below the age of 40. This can be related to an illness like cancer where the hormones need to be suppressed or as a result of ovarian dysfunction. The symptoms will all be similar to varying degrees regardless of age.
Symptoms of the hormone changes that start to occur from 30+ through perimenopause at 40+ to menopause and beyond at 50+
- Low mood – it is known that low mood can commence as the hormones start to change and may well appear 10 years prior in the run up to menopause
- Mood disturbance – Mood swings are very common as Oestrogen levels drop
- Anxiety is a common problem for patients with hormone imbalance
- Disrupted sleep – Waking and feeling like you have hardly slept is often a result of low testosterone
- Hot flushes
- Lack of libido – Sensation as much as desire can be subdued due to low testosterone levels
- Aches & Pains – Patients often complain that they have aches and pains in joints. Due to low oestrogen levels the joints are less supple and lubricated
- Urinary Symptoms – Incontinence – this embarrassing and sometimes debilitating symptom can be helped with Oestrogen replacement.
- Other less known symptoms include: Persistent cough / restless legs / loss of mojo / paranoid feelings / loss of confidence / reduced memory concentration / disorientated – out of body feeling / clumsy / weight gain especially in the abdominal area / dizzy spells / spots / increased facial hair / bloating / abdominal pain / constipation and irritable bowl / snoring / shortness of breath / varicose & thread veins / skin discolouration / chest pain on exertion / fluid retention / breast tenderness / crawling skin / cold hands & feet / headaches / poor wound healing / dry itchy eyes / blurred vision / dry itchy ears / nose bleeds / eczema / Face / Eyes / Jowls / Neck / Decolletage / Tummy / Elbows / Hands / Thighs / Knees
Testosterone Replacement Therapy – I thought Testosterone was a male hormone?
Testosterone is a hormone found in both men and women. In younger females, testosterone levels can be higher than the oestrogen. As this declines symptoms of fatigue, loss of mojo and lack of sexual interest and sensation.
Testosterone replacement therapy is carried out off license, on a named patient basis and the dose is monitored carefully and kept low to avoid androgenic effects of increased facial hair, deepening voice and reduced scalp hair. These side effects are reversible if supplementation is reduced or stopped.
Testosterone is a hormone found in both men and women. In younger females testosterone levels can be higher than the oestrogen. As this declines symptoms of fatigue, poor sleep quality, reduced memory, concentration and attention and loss of motivation, loss of mojo and lack of sexual interest and sensation.
Will I put on weight with HRT?
You should not put on weight with HRT, as you are replacing a deficiency of hormones, rather than giving extra.
When will I stop HRT?
You can continue to use HRT long term. It was arbitrarily stopped after 5 or 10 years in the past because of the previously perceived risk of breast cancer. However, now we know that risk to be less significant following reanalysis of the WHI study of 2002, and that the benefits of HRT now outweigh the risks, we continue treatment long term. Long term benefits include symptom control, improvement in bladder and vaginal health, bone protection in osteoporosis, and reduction in cardiovascular disease.
If you’d like any advice concerning menopause and available treatments please get in touch to book your tailored consultation. Our team are friendly and welcoming, we’re always on hand to offer treatment information.