IT has been a godsend for menopausal women with hot flushes and mood swings – yet hormone replacement therapy is being spurned by a MILLION women over health fears.
And now health watchdog NICE is urging doctors to rethink its use.
Here Dr Carol Cooper looks at its pros and cons. Plus TV host and mum-of-four Ulrika Jonsson, 48, and nutritionist and mum-of-three Dr Marilyn Glenville, 53, author of Natural Solutions to Menopause, give CHRISTINA EARLE opposing views on HRT.
Menopause Q&A
1—WHAT exactly is the menopause?
It’s when a woman stops having periods. For around 80 per cent of women, “the change” brings symptoms such as hot flushes, night sweats, insomnia, mood swings, tiredness and trouble concentrating.
2—What could HRT do for me?
HRT contains the hormone oestrogen, which relieves many of the symptoms associated with the menopause and benefits bone strength too, reducing the risk of fractures.
3—Is it always a pill?
No. HRT also comes in patches, gels, implants and pessaries (vaginal tablets) containing oestrogen. As well as oestrogen, you may need to take progestogen, another hormone, which helps to protect the womb lining.
4—What are the risks of HRT?
There are links with breast cancer, but keep that in perspective because there are other risk factors for cancer, such as obesity, alcohol and age.
If around 1,000 women take HRT for five years, then there might be five extra breast cancers. Cancer of the ovary is also slightly more common with the treatment.
There’s a higher risk of heart disease and stroke with HRT, but only if the drug is started after age 60.
With HRT by mouth, some women are at greater risk of a blood clot (deep vein thrombosis), but other forms of HRT don’t do this. So it’s complicated. Every woman deserves an individual assessment of the pros and cons for her.
5—If the menopause arrives early, is HRT safe?
Around ten per cent of women have an early menopause. Apart from hot flushes and the like, an early menopause brings a higher risk of osteoporosis. A younger woman’s risk of breast cancer and heart disease is low, but HRT has a lot of benefits for her, so it’s a good idea to take it, at least until age 50 or so.
6—If I’ve had breast cancer, can I still take HRT?
The standard answer is no, and you also need to be careful with alternative remedies. Soya (isoflavones), black cohosh, red clover and vitamin E aren’t recommended either.
But you may be able to have topical HRT in the form of pessaries. Talk to a gynaecologist or your cancer specialist.
7— Is HRT a contraceptive?
No. The hormones are not the same as in the Pill. Fertility drops before midlife, but a woman is still considered fertile for two years after she’s had her last period if she’s under 50, or for one year if she’s over 50.
8—What happens if I stop HRT?
Some of the symptoms, such as irritable bladder, predictably return. And the risk of osteoporosis slowly returns to what it would have been before.
With hot flushes and the like, some women will find that they come back, while others are free of them.
9—Isn’t the menopause a natural process?
It is, but so are periods and labour pains, and there are treatments for those. The difference is that the menopause and the years after it are a long-term thing.
If you can achieve the health you want with healthy eating, regular exercise and perhaps a bit less booze (it makes hot flushes worse), then you should stick with that. But consider HRT for severe symptoms.
10—So how can I decide about HRT?
Every woman’s menopause is different. My own hot flushes and night sweats started early. They were bearable, though I find it harder to forgive the massive hot flush I once had on live TV.
In the end it was localised bladder symptoms that drove me to HRT. I’ve been on it five years now and counting, still sticking to the lowest dose that does the job.
The only way to make an informed decision is to talk to your doctor and weigh up the pros and cons for you.
HRT is a drug, and, while it’s similar to your natural hormones, it is not the same. HRT is neither all good nor all bad, and nobody should argue that it should be added to the water.
‘No need to suffer’
— Says ULRIKA JONSSON
I NEVER, ever thought I’d need to think about making a choice about HRT for at least another five to ten years.
I was shocked it was happening to me at 48.
But the evidence stacked up – weight gain, memory loss, anxiety, bad sleep, mood swings, migraines.
After years of suffering at the hands of my hormones – which saw me have ghastly periods in my teens and childbearing for a total of 36 months – there was no way in the world I was going to let them make my life so miserable again. Thankfully, I have a great mum who has had HRT and encouraged me to go down the same route. I agreed that, if there is a treatment or solution out there, why suffer?
From my understanding, the increased risk of breast cancer was established when HRT was first introduced and given to much older women – in their late 60s – and the risk of breast cancer increases as you age anyway. So, from a safety viewpoint I felt confident.
So far, I’ve only been on it for about seven weeks but I already feel calmer which, my husband would like you to know, is a very good thing.
‘Risk isn’t worth it’
— says MARILYN GLENVILLE
I BELIEVE women should avoid HRT where possible. The menopause is a natural stage in a woman’s life that should happen in its own way.
The mistake many women can make is seeing HRT as the answer. But we can cushion some of the uncomfortable symptoms of the menopause with lifestyle changes.
Diet really is key during the menopause. You need to rebalance your hormones with foods high in phytoestrogens (plant compounds that mimic oestrogen) such as chickpeas, soy and lentils. Omega-3 oils from oily fish and egg yolks act as anti-inflammatories to ease joint pain. And you need to focus on antioxidants by eating the whole range of fruits and vegetables – this will help slow ageing.
And make sure your vitamin D levels are sufficiently high to help your body absorb calcium for bone strength and ward off Alzheimer’s, heart disease and diabetes. You can get this from sunlight, wholegrains, dairy and, again, oily fish.
I think the long-term risks of HRT are being played down. The increased risk of breast cancer hooked to HRT just isn’t worth it.