HRT: What You Need To Know Post-Menopause

Firstly, if you’ve been on HRT for a while, how safe is it to take in the long term?
“All medical treatments carry a certain amount of risk, and HRT is no different. For most women under the age of 60, the benefits outweigh the risks. However, for some these risks can mean that it’s not the right treatment to take. Whilst HRT is the most effective treatment for the menopause, long-term use has been associated with a slight increased risk of certain conditions, including breast cancer, ovarian cancer and heart disease. How much of an effect HRT will have depends on many things, such as the type of HRT you take, when you start taking it and for how long. Generally, the longer you take HRT over the age of 50, the higher the risk. For example, taking combined HRT (oestrogen and progestogen) for over a year will slightly increase your risk of breast cancer, but it is important to note that there is no increased risk of dying from breast cancer. Don’t forget that there are also lots of other things that can increase your risk of developing these conditions, such as drinking alcohol, being overweight and not exercising enough. If you are on HRT, it’s important to get checked regularly (at least once a year) by your doctor, to limit any potential risks.” – Dr Samantha Wild, interim women’s health clinical lead at Bupa Health Clinics

“Many women can stay on HRT into their 80s as long as they stay fit and well. If your HRT is prescribed within ten years of menopause (ideally before the age of 60) then it is relatively safe to continue indefinitely. The dose may need to be tweaked as you age, and you may also need to change from an oral preparation to a transdermal preparation to reduce the risk of blood clots, but there are no restrictions in time limits.” – Dr Shahzadi Harper, GP specialising in women’s wellbeing and founder of The Harper Clinic
 
 
What does the science say?
“In the early 2000s, the results of two large studies were published. These raised concerns regarding the safety of HRT, particularly with regards to breast cancer and heart disease, and caused widespread panic and confusion amongst patients and doctors alike. Many doctors stopped prescribing HRT and many women abandoned HRT immediately. The number of women taking HRT fell by 66%, which has not changed, so that now after more than a decade, there has been a generation of women who have mostly been denied the opportunity of improved quality of life during their menopausal years. Despite the initial findings, the studies were shown to be flawed. If women start HRT around the time of menopause the risk is very small, but there is only limited data for continued usage beyond the age of 60. It is not usually appropriate for women over 60 to be starting HRT, but this does not mean that women who started HRT earlier should have to stop it when they reach 60.” – Dr Shirin Lakhani, cosmetic doctor and intimate health specialist 
  
 
So, is there an age when it’s too late to start HRT?
“NICE guidelines state that HRT should be commenced under the age of 60 or within ten years of menopause, but that doesn’t mean HRT can’t be started at a later age. However, as you age, it’s important to understand and recognise that your general medical risk increases, largely due to the ageing process and due to the fact that your body has not had some of the protective effects of oestrogen. Starting HRT at a later age is possible, but it should ideally be done with the understanding that your baseline risk is higher than if you were to start at the age of 50.” – Dr Harper 
  
 
What’s the difference between the various types of HRT? 
“The most common way of taking HRT is in tablet form – either combined or oestrogen-only. This method of HRT suits those without a history of heart disease, stroke or liver problems. Although the risk is very low, taking HRT in this form can increase your risk of developing these conditions. HRT patches, meanwhile, may be more suitable if you are at risk of liver disease, or are prone to migraines. Patches are a simple way to take HRT: you stick a self-adhesive patch to your skin below your waist, and you’ll need to change it once or twice a week. You can also apply HRT through the skin as a gel, which is associated with fewer risks than taking HRT in tablet form. Oestrogen also comes in the form of vaginal tablets, rings or creams. Your doctor may recommend these for you if you have vaginal dryness or bladder symptoms. This type of HRT will increase oestrogen levels locally in the tissues that need it without affecting your whole body and is associated with fewer risks. New micronised progesterone tablets are now available, which carry an even lower risk of breast cancer – these are increasingly being prescribed.” – Dr Wild 
  
 
Are there any side effects?
“When you start taking HRT, you may notice bloating, headaches and breast tenderness, although these side effects will often pass within a few weeks. In terms of more serious complications, oral HRT (both combined and oestrogen-only) increases the risk of blood clots in your legs and lungs by two to four times, but this risk is still very low. For every 1,000 women taking HRT for seven and a half years, fewer than two will develop a blood clot.” – Dr Wild 
  
 
Is it true you should stop taking HRT after five years?
“Doctors tend to suggest that women stop taking HRT after around five years as the risk of breast cancer increases after this time. However, the advice from NICE – and something I agree with – is that women shouldn’t be advised to stop taking HRT after any arbitrary time limit, whether that be two or five years. Often, women stop after five years because their doctors refuse to prescribe it with the mistaken belief it has a maximum five-year limit. An individualised approach is vital and the decision to stop taking HRT needs to come from a balanced discussion with a practitioner who has specialist knowledge in the field.” – Dr Lakhani
  
 
How should you adjust your dose as you age?
“Younger women often need higher doses of HRT, and if it is used for those over the age of 60, you will likely begin with a lower dose of HRT and almost certainly not a tablet form. If you only have a few symptoms, it may be a low dose to start, but this may need to be altered with time. As your symptoms begin to ease, your GP may lower your dose further. However, there may be times when you need a little more. Your GP or doctor should support you at every step.” – Dr Wild

If you’ve had breast cancer, is it safe to continue with HRT?
“HRT may not be suitable if you have a history of breast cancer – you’ll need to discuss your medical history with your oncologist and a menopause specialist first. For some women, the benefits of taking HRT if they are very debilitated with symptoms may still outweigh the risks.” – Dr Wild

“If you have had breast cancer, you can have vaginal oestrogen safely. You may also be able to have HRT once your treatment protocol has finished and you are in remission. The only exception is if you’ve had hormone dependent breast cancer, which is fuelled by oestrogen and progesterone, which account for 70% of breast cancers. In this case, HRT may not be suitable.” – Dr Harper 
 
 
How can you wean yourself off HRT?
“You should never wean yourself off HRT without medical input. Typically, your doctor will advise a gradual reduction over a period of a few weeks that’s in line with your individual needs.” – Dr Lakhani
 
 
If you want to try something else, what are your options?
“There’s nothing else similar to HRT but there are treatments that can help tackle the symptoms associated with menopause. For example, one of the ways in which vaginal dryness and painful intercourse can be addressed is with the O-Shot – a non-surgical procedure that involves withdrawing your blood, processing it to create platelet-rich plasma (PRP) and then re-injecting it into the intimate areas. PRP is rich in grow factors, naturally occurring substances that stimulate cell growth and tissue rejuvenation; when injected, it can rejuvenate the G-spot, clitoris and labia, allowing women to have prolonged multiple orgasms. The procedure costs around £1,200 and takes 45 minutes. If you are experiencing prolapse as a result of menopause and aren’t prepared to go down the surgery route, vaginal rejuvenation with Ultra Femme 360 could be an option. It works by delivering radio frequency to underlying fibres in the vagina, triggering the skin to produce collagen, leading to increased tightness. It can decrease the diameter of the vaginal opening and canal and improve natural sensation and lubrication.” – Dr Lakhani 

If you want to go down a natural, hormone-free path, leading nutritionist specialising in women’s health Dr Marilyn Glenville shares her top tips for weaning yourself off HRT…

 
 
Go Slowly
“If you are looking to stop HRT, consider a gradual weaning process. Stopping HRT suddenly is similar to going cold turkey and there have been reports of rebound effects from the quick withdrawal of hormones. These rebound effects can give tremendous hot flushes and seemingly worsened menopausal symptoms. It’s better to take three months to come off HRT gradually. Make sure you are eating well so you are in the best health by the time you stop completely and take a good-quality multivitamin to ensure optimum levels of nutrients. Ask your doctor for a lower dose and if you cannot reduce your dose, consider switching to a patch. Patches deliver hormones through the skin, meaning it doesn’t have to be broken down by the liver first, so you can get away with a lower dose than if it was taken orally.”
 
 
At The Same Time, Increase Your Intake Of Phytoestrogens
“Foods rich in phytoestrogens – think tofu, flaxseeds, sesame seeds, edamame, fennel and garlic – will help cushion the effects of the hormone rollercoaster. Women who eat a diet rich in phytoestrogens have significantly fewer hot flushes. Phytoestrogens work like a key. The cells in your body have oestrogen receptors on them that act like a lock; they need a key that fits into that lock to ‘stimulate’ them into activity. This activity can be beneficial in certain places in the body like your bones and brain where you want the cells to stay active but can be negative in other places like the breasts and womb where you do not want cells to be too stimulated, causing them to multiply and then mutate. There are two different kinds of oestrogen receptors, alpha and beta. Isoflavones bind to beta-receptors and stimulate beneficial effects in the brain, bones, heart and bladder.”
  
 
Get A Helping Hand From Herbs
“There are a number of herbs that are helpful for the menopause including soya, sage, flaxseeds, hops and red clover. Sage has been shown to decrease hot flushes by 50% after four weeks and by 64% after eight weeks. It also helps with insomnia, irritability, anxiety, physical and mental exhaustion by up to 47%. Red clover is one of the most extensively studied herbs and research indicates that it significantly reduces vasomotor symptoms compared to a placebo. A combination of these herbs can be found in NHP’s Meno Herbal Support.”
  
 
Balance Blood Sugar Levels To Help Your Mood
“If you are suffering from mood swings, irritability and depression then taking measures to balance your blood sugar is crucial. This means not only thinking about the quality of the food that you eat but also the timing. You need to completely eliminate added sugar and refined carbohydrates in order to see a marked improvement in your moods. Try to eat little and often, at least every three hours. If you wait longer than this, your blood sugar will drop, and the stress hormones adrenaline and cortisol will be released. It is the release of these hormones that gives rise to many of the symptoms relating to anxiety, tension, crying spells, depression and irritability.”
  
 
Stress Less
“It is well known that the more stressed you are the more severe the menopause symptoms can be as your adrenal glands are the major source of oestrogen through the menopause. Look at the stress in your life and see what you can control. Reducing or eliminating caffeine can help and consider taking a supplement such as NHP’s Tranquil Woman Support.”
  
 
Look After Your Joints 
“Aching and stiff joints are common after the menopause, caused by a decrease in oestrogen.  Eat plenty of foods rich in omega 3 fatty acids, such as oily fish, nuts and seeds as these foods help create anti-inflammatory prostaglandins that can ease the pain and inflammation of swollen joints. If you don’t tend to eat these foods, consider taking an omega-3 fish oil supplement that contains at least 700mg EPA and 500mg DHA per day – I recommend NHP’s Omega-3 Plus. Also try to cut down or eliminate red meat as this can contribute to the production of ‘bad’ prostaglandins that will increase inflammation in the joints.”
  
 
Natural Solutions To Menopause by Dr Marilyn Glenville is available now; visit NaturalHealthPractice.com. For more information or to book a consultation with one of the specialists, visit TheHarperClinic.com, Elite-Aesthetics.co.uk and Bupa.co.uk. 
  
 
DISCLAIMER: Features published by SheerLuxe are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.