Hormone replacement therapy explained

As a woman, you’ve probably got a lot of questions about Hormone Replacement Therapy (HRT). Does it actually reduce menopausal symptoms? Is it safe? Is it right for you? Here, DR JUNE TAN SHEREN from Osler Health International fills us in on the HRT facts so that you can make an educated decision about your menopause experience.

What is hormone replacement therapy?

Hormone Replacement Therapy, or HRT, is used to treat symptoms that come along with menopause. A normal and natural process in all women’s lives, menopause occurs when the ovaries stop producing follicles. This leads to lower levels of oestrogen and other hormones. The average age of menopause is 51 years old, while peri-menopause (the stage around or near menopause) can start any time from 45 to 55 years of age.

The aim of HRT is to replace the oestrogen hormones that the female body stopped producing during menopause.

There are different types of HRT that can be used in association with different health risks. So, the type your friend is taking may not be beneficial for you.

Why take HRT?

I believe that HRT is the most effective way of improving the not-so-delightful symptoms that can come with peri-menopause and menopause.

Common menopause symptoms

While some women don’t experience symptoms at all, many peri-menopausal and menopausal women experience a variety of symptoms with varying severities and durations. One of the most common menopausal symptoms is hot flashes. In fact, it’s estimated that up to 80 percent of women experience hot flashes, with or without night sweats.

Other common menopause symptoms include:

• vaginal dryness
• fatigue
• mood swings
• insomnia or disturbed sleep
• decreased libido
• memory problems
• muscle aches and joint pains
• headaches
• irritability
• anxiety
• urinary frequency

Taking HRT can relieve women of these menopausal symptoms.

Additional health benefits of HRT

In addition to reducing menopausal symptoms, HRT is one of the most important ways to prevent and treat osteoporosis – the weakening of bones that can result in a higher risk of fractures. Research shows that HRT can improve bone density, which is particularly important during menopause, when bones weaken from lower oestrogen levels.

HRT has also been shown to reduce the risk of diabetes and heart disease for some women. And recent studies indicate that HRT benefits the cardiovascular system through its effects on cholesterol, glucose metabolism, and arterial function.

What are the different types of hormone replacement therapy?

HRT can be given in the form of oral tablets, gels and patches to be applied on the skin, as well as vaginal pessaries for insertion.

The type of HRT needed really depends on the individual’s age, whether she’s had a hysterectomy and whether she has other health conditions. Your doctor can tailor the type of hormone treatment best suited to you.

HRT can be oestrogen-only, used in women who’ve had their womb removed (hysterectomy). Women who have their uterus intact will need progesterone combined with oestrogen to protect the womb lining. This is known as combined HRT. It can be given in a cyclical form to bring about a bleed like a normal menstrual cycle, or as continuous combined HRT, which is period-free.

If a woman experienced an early menopause, she should continue treatment at least until the average age of menopause (around 51 years), if there are no contraindications.

Are there any risks with taking HRT?

The safety of HRT was called into question about 20 years ago when a study known as the Women’s Health Initiative reported increased breast cancer risk and heart disease from HRT. This had a major impact on menopause treatment practices, which still continues today.

Since then, higher quality research has been conducted, and past research has been re-analysed. The latest findings are that HRT is safe to use in most women – women with low underlying risk of breast cancer – if started in their 50s or those who start HRT within 10 years of menopause. The risk of breast cancer with HRT is less than that of being overweight or drinking two or more alcoholic drinks a day. So, most women will not be diagnosed with breast cancer as a result of their exposure to HRT.

The risk of blood clots while taking HRT is similar to that for other risk factors like being overweight or cigarette smoking. There is, in fact, no increased risk of blood clots from HRT gels or patches.

Caution with HRT use is advised in women with abnormal vaginal bleeding that has not been evaluated, and women with personal histories of breast cancer, established cardiovascular disease, or active liver disease.

When should a woman start hormone replacement therapy?

Many women wait until their symptoms are really troublesome, or even unbearable, before starting hormone replacement therapy. However, taking HRT early can really make a difference to a woman’s quality of life.

Women with premature menopause before the age of 40 (called Premature Ovarian Insufficiency) are usually advised to take HRT, and continue to do so until at least the natural age of menopause (around 51), as long as there are no contraindications. Doing so has shown to have protective effects from cardiovascular disease, osteoporosis and cognitive impairment in this group of women. Often, this is also true for women experiencing early menopause before the age of 45 years, whether naturally or due to surgical  ovary removal.

But, remember – HRT is not a contraception. If you still require contraception, talk to your doctor about the options available to you.

How do I decide what I need?

Consult a GP to discuss if and which HRT is right for you. No two women are alike. So, it’s essential to individualise treatment, depending on your symptoms, medical background, personal preferences and priorities.

Your doctor will take your your medical history, do an examination and possibly run some tests to assess your suitability for HRT. This will help determine which type is best for you. This is also a good opportunity to check that you are up to date with routine screenings like cervical and breast screenings.

Got more questions about hormone replacement therapy?

Check out Osler Health International’s menopause and HRT fact sheet (it’s got loads of great information), or schedule an appointment by calling 6332 2727.

Osler Health International
#02-27/02-34 Raffles Hotel Arcade, 328 North Bridge Road 
#B1-27, The Star Vista, 1 Vista Exchange Green 
osler-health.com

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