Menopause affects every woman differently, but for many the symptoms are significant and long-lasting. Yet despite effective treatments being available, many women never seek help.
This podcast from NHS Ayrshire and Arran explains how hormone replacement therapy works, the different forms it can take, and how to use it safely and effectively to manage the symptoms of perimenopause and menopause. One size does not fit all when it comes to HRT, and patient knowledge and understanding of the options available is essential for safe and effective use.
For more information, speak to your GP, practice nurse or pharmacist, or visit the links below.
Women’s Health Concern: womens-health-concern.org/wp-content/uploads/2022/11/27-WHC-FACTSHEET-HRT
Image Source: Adobe Stock Images / RFBSIP
Transcript
Hello, and welcome to ResearchPod.
In this podcast we’re going to look at female menopause and how to treat it safely and effectively using hormone replacement therapy – HRT.
Menopause is the biological stage in a woman’s life when her periods stop and she can no longer have children. This is because her ovaries produce smaller amounts of the natural female sex hormones oestrogen and progesterone.
Menopause usually happens between the ages of 45 and 55, but it can start earlier, and the average age is 51. Leading up to this, hormone levels begin to fluctuate and periods become irregular. This stage of life is known as the perimenopause and on average it lasts about five to seven years.
Every woman experiences perimenopause and menopause differently. But the hormonal changes are significant and can result in a wide range of physical and psychological symptoms. These include hot flushes and sleep problems, as well as mood swings and brain fog.
Not everyone has the same symptoms, but statistics show how much of a problem they can be.
For example, the British Menopause Society conducted a survey of women aged between 45 and 65. It found that eight out of ten interviewees experienced hot flushes, and seven out of ten experienced night sweats. In addition, more than a fifth of women reported problems with sleeping, and the same number had issues with memory or concentration.
These symptoms affect many aspects of women’s lives. The same survey found that more than half the women who took part said it had an impact on their sex lives. In addition, just under half found work a struggle, and a third reported that they felt less outgoing, which affected their home lives as well as their social lives.
Symptoms can also last a long time. The average is seven years, but for some women it’s longer.
Given the impact of menopause and perimenopause, it’s perhaps surprising that many women don’t ask health professionals for help.
This may be because they’re embarrassed and reluctant to talk about their symptoms, or because they feel they simply have to put up with them. Alternatively, women may fear that doctors will dismiss their concerns, or think they’re time-wasting. It may also be that they haven’t connected their symptoms with menopause, or that they’re unaware of the treatment available, or because they fear it’s not safe.
Whatever the reason, NHS Ayrshire and Arran can help. As one of the biggest employers in the area, we’re already talking about menopause with our own staff, three-quarters of whom are female, and nearly half are aged 45 or over.
The fact is that hormone replacement therapy – HRT – is a safe and effective treatment for the symptoms of perimenopause and menopause.
HRT works by supplementing your natural hormone levels which start to lower in perimenopause. There is no one-size-fits-all treatment, and health practitioners will take various factors into account to provide you with a personalised regime. This includes, for example, your medical history, menstrual cycle and symptoms, as well as your preferences.
Therapy can usually begin as soon as you’re aware of your symptoms. In some cases you may have to have a blood test first, to measure your current hormone levels. This may be the case, for example, if you’re 40 to 45 years old, or if you’re younger than 40. Menopause occurring in those younger than 40 is called Premature Ovarian Insufficiency.
Hormone replacement therapy can be used in two ways – locally or systemically.
Local HRT targets the specific area of the genital tract and bladder to relieve symptoms such as vaginal dryness and irritation, as well as urinary urgency. For this treatment you’ll usually be given a low dose of oestrogen in the form of a vaginal gel, pessaries, a ring, or cream.
Systemic HRT treats a wider range of symptoms such as hot flushes, night sweats and mood swings. It does this by delivering either a higher dose of oestrogen only, or a balanced dose of both oestrogen and progestogen, into the whole body.
Which hormones you’re prescribed depends on your medical history.
If you’ve had a hysterectomy, you’ll usually be prescribed oestrogen only.
If you haven’t had a hysterectomy and still have a womb, you’ll usually be offered a balanced combination of oestrogen and progestogen. This is because giving oestrogen alone can make the womb lining thicken and increase the risk of womb cancer. Adding progestogen to the treatment helps to protect the womb lining, and so reduces risk.
This combined form of systemic HRT can be given in different ways.
You may be prescribed patches or pills which contain both oestrogen and progestogen. Alternatively you may be given the hormones separately. For example, you may be offered patches, a gel, or a spray to deliver oestrogen, and tablets or a hormonal coil for the progestegon.
Health practitioners will have thought carefully about how much of each hormone you need, and in what form it should be given. This will depend on such things as your symptoms, age and medical history. It’s really important that you take your HRT treatment exactly as it’s prescribed.
As well as the strength of the hormones to prescribe, for women with menopause symptoms who haven’t had a hysterectomy, health practitioners also have to decide whether to offer you systemic combined HRT on a continuous or a cyclical basis.
For example, if you haven’t had a period for more than a year, and / or you’re aged 54 or older, you’ll usually be given combined oestrogen and progestogen on a continuous, daily basis.
If you have had a period in the last year, you will usually be given oestrogen and progestogen in a cyclical regime which aims to mimic your 28-day menstrual cycle. This means that you’ll take oestrogen every day, and on the final 14 days of the month you’ll also take progestogen. After that you’ll usually have a period-like bleed, but you must start the next treatment cycle as soon as the last cycle finishes, without a break.
You will usually follow this cyclical regime for two to five years. After that, your health practitioner may suggest you switch to taking combined oestrogen and progestogen on a continuous daily basis.
HRT is a safe and effective treatment for most women with menopausal symptoms, but it should only be taken in consultation with health practitioners.
Like all medicines, HRT is not entirely risk-free and it can have side effects. These include fluid retention, bloating, and breast tenderness or swelling, as well as headaches, indigestion, and vaginal bleeding. The side effects usually improve over time, but if they don’t, you should consult your doctor so they can review your treatment.
Media coverage of HRT has increased significantly in recent years, but HRT is still associated with myths, for example, that it can lead to weight gain. You may put on weight during menopause, but this can happen anyway – whether or not you’re taking HRT.
In the past there have also been fears that HRT can cause breast cancer. There can be a small increased risk of breast cancer in those taking HRT but this depends on the type of HRT and the duration of use. Being overweight, drinking more than 2 units of alcohol a day and having a sedentary lifestyle all increase the risk of breast cancer significantly more than HRT.
There are additional benefits to HRT that go beyond menopause treatment. For example, HRT can help to prevent weakening of the bones – osteoporosis – which is a risk for post-menopausal women. It may also provide protection against heart disease.
There’s a lot to think about before you begin HRT. It’s therefore vital that you talk to a health practitioner to make sure you understand the associated benefits and risks, as well as the different treatments that are available and how you should take them.
Thanks for listening to this podcast, and remember that, although menopause can be challenging, your GP, practice nurse, and pharmacist can help.
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