Is HRT always the answer?

Some thoughts from Dr Sharon Wasson, GP at Middlewood, with a Special Interest in Women’s Health and the Menopause

I have had an interest in Menopause health for over 20 years and have seen the very real and distressing effects this natural transition can have on many women.

I have also seen the dramatic swings in the popularity of HRT over the years. I remember Dr Jean Coope, a partner at Bollington and a huge advocate for HRT, teaching me about its benefits when I joined the practice in 1997. I then remember the publication of the Women’s Health Initiative study and the Million Women Study in the early 2000s, and the significant backlash against HRT. After this, women were very afraid of using HRT, and I can remember finding it very hard to convince them of the benefits.

Now we have seen a large upswing in the popularity of HRT, led by many celebrities and specialist doctors. On the whole this is good news, however my colleagues and I are concerned that the benefits of HRT are being over-stated and that it is being recommended for situations which are perhaps better resolved in alternative ways.

If HRT is prescribed to women under the age of 60, and within the 10year period around the menopause, then the benefits usually out way the risks. We would recommend HRT to manage the symptoms of the menopause if the woman is finding her symptoms problematic. HRT also protects against osteoporosis, particularly if you have an early menopause.

However, combined HRT (the commonest form, taken if you still have a uterus) is associated with a small risk of breast cancer, the risk increasing the longer you take it. Also, the beneficial effects on the cardiovascular system decrease as you enter your 60s and your risk of having angina, heart attack or stroke increase if you take HRT as you get older. There are mixed results when looking at the effects of HRT on dementia, and currently there is little evidence to suggest that HRT helps with issues like “brain fog”. There are also no studies looking at using HRT for early perimenopausal symptoms in women in their early 40s, and the long-term effects are currently unknown.

There are some alternative ways to help menopausal women which are being forgotten and are very valuable:

Lifestyle modifications can be significantly beneficial for menopausal symptoms as well as overall health. For example, when your body is stressed, it diverts the hormone production away from producing sex hormones such as Oestrogen and Testosterone, and instead boosts the production of stress hormones such as Cortisol. Indeed, a study conducted in 2016 showed that a 12-week trial of yoga significantly reduced menopausal symptoms and improved quality of life.

The menopause can be a time to look at our lifestyle, and perhaps change any bad habits we have developed. For example, having a healthy diet, keeping alcohol intake within safe levels and trying some regular exercise.  Phyto-oestrogens are plant oestrogens which have been shown to help some women with hot flushes. They are naturally found in foods such as soya, and the WAVS trial (Women’s study for alleviation of Vasomotor Symptoms) found that incorporating soya decreased moderate to severe hot flushes by 84%. Phyto-oestrogen supplements are also available to buy over the counter in various forms. Your pharmacist will be able to assist you.

Antidepressants have a role to play in managing symptoms, such as to help with hot flushes if the lady cannot, or does not wish to, use hormones.

They can also play a very valuable role in managing the unpleasant premenstrual type symptoms which often get worse in the perimenopause.

Cognitive Behavioural Therapy has been shown to be very beneficial in managing some of the symptoms of the menopause. Our psychology service, Talking Therapies, runs a one-day workshop specifically helping with the menopause. You can see details and self-refer for this via this link

There is no doubt that the menopause impacts on a lot of women and affects their ability to function normally and at their usual level. We are very pleased to see this acknowledged and would encourage all businesses to become more Menopause Aware and to have a menopause policy. The British Menopause Society have produced a fact sheet to help employers design a Menopause policy

We would encourage you to contact us via the Ask My GP system to discuss your menopause with us; we have several clinicians with an interest in Women’s Health and you are able to request a consultation with them.

You may wish to look at this website prior to your discussion, so you are fully informed.

Finally, here is The British Menopause Society response to Davina’s latest programme: