HRT: The Most Common Myths Uncovered
HRT: The Most Common Myths Uncovered

HRT: The Most Common Myths Uncovered

HRT continues to be a tricky topic in the health world. Following headlines in the early 2000s suggesting it increases the risk of breast cancer and cardiovascular disease, many women stopped taking it altogether. Today, some apprehension remains in those suffering from menopausal and post-menopausal symptoms. Navigating how it works and who needs it can be daunting, so we asked five women’s health specialists to sort the facts from fiction…

MYTH: HRT Should Only Be Taken When Your Periods Have Finished

TRUTH: “This is a common misbelief by many. Women can start taking HRT during the perimenopause as this will top up the missing hormones. In fact, studies have shown that the earlier women take HRT, the better for their future health, as well as improving their symptoms sooner. So, in short, don’t hold off having the conversation if you’re thinking about giving it a go.” – Dr Louise Newson, GP & renowned menopause specialist 

MYTH: It Shouldn’t Be Used As A Long-Term Solution

TRUTH: “The menopause is a long-term hormone deficiency with health risks. Therefore, it is sensible to take HRT for ever to improve future health as well as improve symptoms. The guidelines are very clear that women can continue taking HRT as long as the benefits outweigh the risks which, for the vast majority of women, is for ever. Women can take HRT without stopping it in the same way that women who have an underactive thyroid gland would take thyroxine, another hormone, for ever.” – Dr Louise

“HRT is worth sticking with long-term and health professionals will recommend that if you do want to stop taking it, you gradually decrease your dose. Why? Because this has been shown to lessen the chances of menopausal symptoms returning in the short term. Should symptoms persist for several months after your treatment has stopped, then you should contact your HRT provider immediately to decide what the best next steps are. Choosing to stop HRT treatment should always be after consultation with a health professional or HRT specialist. Unless there is a specific medical reason as to why you should stop immediately, you will be advised to try a lower dose for three to six months to wean yourself off the treatment gradually.” – Mike Kocsis, director of healthcare, Balance My Hormones

MYTH: You Can’t Choose The Amount You Take

TRUTH: “Wrong. Some women put up with the symptoms of menopause for many years before they decide that enough is enough and turn to HRT. Often, these women require smaller doses of oestrogen and such preparations have been designed specifically for the older woman – there isn’t a one-size-fits-all. Even in such small doses, the HRT treatment can be extremely effective in alleviating symptoms as well as offering protection against osteoporosis and heart disease.” – Mike  

“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 in 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 and it can be tweaked consistently.” – Dr Samantha Wild, interim women’s health clinical lead at Bupa Health Clinics

It’s a common MISCONCEPTION that HRT will make you GAIN WEIGHT and there’s no evidence to support this.

MYTH: Staying On HRT Is Bad For Your Health

TRUTH: “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. While 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 

“Many women can stay on HRT into their 80s if 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

MYTH: HRT Is A Key Cause Of Weight Gain

TRUTH: “It’s a common misconception that HRT will make you gain weight and there’s no evidence to support this. Women do sometimes gain weight during the menopause; however this is often regardless of whether you take HRT and can be down to a combination of hormone changes and lifestyle factorsm and can be addressed with nutrition and exercise.” – Dr Martin Kinsella, cosmetic doctor & hormone expert

MYTH: Bioidentical Hormones Are Safer & More Natural 

TRUTH: “Compound bioidentical hormones are neither regulated nor licensed. They are not safer than regulated body identical hormones in HRT and therefore should not be used. They are given in some private clinics and are very expensive without any evidence to support their use.” – Dr Louise 

“Recently, bioidentical hormones – as opposed to body identical hormones – have been marketed as a safer alternative to standard HRT as these are hormone preparations made from plant sources. However, it is important to note that these preparations are not regulated and there is no evidence to suggest that they are indeed safer or even as effective as traditional HRT.  In fact, they are prepared, based on the hormone levels present in your saliva although there have been no studies which have proven that the hormones in your saliva are directly related to the symptoms of menopause.” – Mike 

MYTH: You Shouldn’t Take HRT Beyond The Age Of 60

TRUTH: “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

“Although studies show that more benefits are provided in women who start HRT early, there is still benefit, especially to strengthening bones, in women who start taking HRT when they are older. As there is no risk of clot or stroke with oestrogen given through the skin, HRT that is prescribed now is much safer than older types of HRT so again it is much safer to give to older women.” – Dr Louise

As well as EASING SYMPTOMS that are associated with the menopause (mood swings, irritability and hot flushes), HRT can help with a NUMBER of OTHER THINGS, too.

MYTH: HRT Is Suitable For Everyone

TRUTH: “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 who are very debilitated with symptoms, the benefits of taking HRT 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 

MYTH: There Is Only One Type Of HRT

TRUTH: “The safest way of having oestrogen in HRT is as a patch, gel or spray which goes directly through the skin into the bloodstream. This does not increase the risk of clot or stroke and is readily absorbed. Tablet oestrogen is associated with a small risk of clot. The safest way of having progesterone is a micronised progesterone capsule which is body identical progesterone, meaning it is the same structure as the progesterone women produce before the menopause. Older types of progesterone are core progestogens and they are associated with a small increased risk of clot and heart disease. Body identical hormones are derived from the yam plants and are very safe.” – Dr Louise 

MYTH: It Can Cause Heart Problems 

TRUTH: “As well as easing symptoms that are associated with the menopause (mood swings, irritability and hot flushes), HRT can help with a number of other things, too. That includes women who have had their ovaries removed at a young age, or those who have experience early menopause. Likewise, it offers increased protection against heart disease, contrary to popular belief, as well as osteoporosis, stroke and dementia. It’s why it is best to start HRT as soon as you can to stay on top of your overall health.” – Mike 

“Not only does HRT help boost heart health and alleviate many of the symptoms of menopause, it can also prevent bone thinning which can lead to osteoporosis. HRT can even offer protection against fractures. If you reach the menopause before 45 you lose the protection that oestrogen gives your bones at an earlier age than normal and so the risk of osteoporosis and broken bones increases. In these situations, HRT can be very beneficial to protect your bone health the earlier you begin taking it.” – Dr Martin

MYTH: HRT Alone Will Reduce All Menopause Symptoms

TRUTH: “HRT isn’t the only thing that will keep menopausal symptoms in check. Looking at diet and lifestyle can help to address issues, too. Regular exercise and reducing your intake of caffeine and alcohol can be beneficial. When you go through the menopause your oestrogen levels drop and, because oestrogen maintains bones density, this can lead to low bone density. For this reason, it’s a good idea to ensure that your diet is high in phyto-oestrogens such as soya beans, tofu, peanuts, kidney beans, chickpeas, grains, wheat, rye and sunflower seeds. Calcium-rich foods are also important to prevent osteoporosis, and it’s recommended that women on HRT should have at least 1,000mg of calcium daily (for reference, one glass of milk is about 300mg of calcium). I would also advise people on HRT to avoid consuming too much saturated fat and sugar because both can decrease the body’s ability to metabolise oestrogen. Instead, good quality protein such as lean meat, fish and eggs as well as vegetarian alternatives are advisable. People on HRT should limit their caffeine intake because this can negatively impact calcium levels, and the phosphorus in fizzy drinks can increase bone loss so these should be avoided too.” – Dr Martin

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