What is Menopause?
Menopause marks the end of a woman’s menstrual cycles due to a natural decline in ovarian function, meaning the ovaries stop producing hormones like oestrogen, progesterone, and testosterone. Typically occurring between the ages of 45 and 55, with the UK average at 51, menopause is officially diagnosed when a woman hasn’t had a period for one year. Before this stage, many experience perimenopause, where symptoms gradually appear due to reduced oestrogen levels.
Symptoms of Menopause and Perimenopause
As oestrogen levels decrease, women may experience a range of symptoms including:
- Hot flashes and night sweats
- Vaginal dryness
- Insomnia
- Headaches and brain fog
- Mood swings and reduced libido
- Urinary symptomsÂ
Beyond these immediate symptoms, the drop in oestrogen can also impact long-term health, particularly affecting bone density and heart health.
Hormone Replacement Therapy (HRT)
What is HRT?
Hormone Replacement Therapy (HRT) is the most effective treatment for managing menopausal symptoms. It works by replacing the hormones the body no longer produces, mainly estrogen and progesterone, and in some cases, testosterone.
Types of HRT
HRT comes in several forms, including patches, gels, sprays, and tablets. Some forms, called “body identical” HRT, closely mimic the body’s natural hormones and tend to have fewer side effects. There are also “bio-identical” hormones, compounded in special pharmacies, but these aren’t recommended by major health bodies like the British Menopause Society because they don’t carry official medicine licenses.
How HRT Works
1. Oestrogen-Only HRT
Oestrogen is the core component of all HRT types and helps relieve symptoms like hot flashes while protecting bone and heart health. Women who’ve had a hysterectomy (removal of the womb) can take oestrogen alone. It’s available as a tablet, patch, gel, or implant in varying doses.
2. Combined HRT (Oestrogen + Progesterone/Progestogen)
For women who still have their womb, progesterone (or progestogen) is added to oestrogen to protect the womb lining (endometrium) from thickening, which could lead to cancer over time.
3. Local Oestrogen for Vaginal Symptoms
If menopausal symptoms mainly affect the vaginal or urinary area, a low-dose oestrogen cream, tablet, or ring can be applied directly. These treatments raise oestrogen levels locally and are safe for women who either can’t or prefer not to use systemic HRT. No additional progesterone is needed with these low-dose treatments.
The HRT Controversy: Clearing the Confusion
Despite concerns raised in the early 2000s about HRT increasing breast cancer risk, more recent research shows that for most women, the benefits of HRT outweigh the risks. The findings of the Women’s Health Initiative Study in 2002 were misinterpreted, particularly regarding the link between HRT and breast cancer.
- Breast Cancer Risk: Modern, body identical HRT, which is closer to the body’s natural hormones, carries the least risk. For women using this type of HRT up to five years after menopause, there’s no significant increase in breast cancer risk. Even in women with a family history of breast cancer, HRT doesn’t raise their risk above their baseline.Â
- Lifestyle Factors: Obesity, alcohol consumption, and lack of exercise are actually more significant risk factors for breast cancer than older forms of synthetic HRT.Â
- Blood Clot and Stroke Risk: Women at higher risk for blood clots or stroke can reduce this risk by using HRT in a patch, gel, or spray form, as these methods deliver oestrogen through the skin rather than orally.
Conclusion
For most women, HRT is a safe and effective way to manage menopausal symptoms and protect long-term health. With more research supporting the safety of body identical HRT, women can feel more confident about their options during and after menopause. However, it’s important to discuss individual risks and benefits with a healthcare provider to make the best choice for your health and lifestyle.