Menopause and HRT

Menopause actually occurs one yearafter your last menstrual period. Theterm perimenopause is often usedwhich describes the time when youhave menopausal symptoms beforeyour periods actually stop all together.Some women continue to haveperiods when they experiencesymptoms of the menopause.

The average age of the menopause inthe UK is 51 years. It can be commonto have some menopausal symptomswhen you are in your late 40s.

Your menopause is described as beingearly if it occurs before the age of 45and it is called Premature OvarianInsufficiency (POI) if it occurs beforethe age of 40 years. Women who havean early menopause or POI absolutelyneed to take hormones, usually in theform of hormone replacement therapy(HRT), and there are no risks of takingHRT at a younger age.

The menopause usually occurs whenyour ovaries stop producing eggs and

also make less oestrogen (the mainfemale hormone). This is usually a resultof aging and is a normal process.

If you have an operation to removeyour ovaries (oophorectomy) then it isvery likely you will experiencemenopausal symptoms, which can bevery severe. It is important that youdiscuss the option of HRT with yourdoctor before having an operation. Ifyou have had a hysterectomy (removalof your womb) then your ovaries areactually more likely to stop workingproperly earlier than they would dootherwise.

Women who have had radiotherapyto their pelvic area or some types ofchemotherapy as treatment for sometypes of cancer and lead to an earlymenopause occurring.

An early menopause can run in somefamilies. So it can be worthwhile askingyour mother and other female familymembers how old they were whentheir periods stopped.

What is the menopause?

What are the symptoms of the menopause?

The menopause is a natural event.Every woman will go through it atsome point. Some women have veryfew or even no symptoms and theirperiods simply stop happening.However, for the majority of womenit is not so straightforward and around

80% of all women experience severalsymptoms. Around 25% of thesewomen have very severe symptoms.The symptoms you may experiencevary between different women andcan change with time. These symptomsoften have a very negative impact on

Commonly known symptoms include:

• Hot flushes• Night sweats• Mood swings• Tiredness

• Poor sleep• Poor concentration• Lack of libido

Less commonly known symptoms include:

• Heavy periods• Muscle and joint pains• Hair and skin changes (such as dry

or itchy skin)• Depression, anxiety and irritability• Memory problems• Panic attacks• Worsening headaches and migraines

• Worsening PMS (premenstrualsyndrome)

• Vaginal dryness, itching or soreness• Pain during sexual intercourse• Urinary symptoms such as

increased frequency passing urine

Testing for the menopause

Most women over the age of 45years who have typical symptoms ofthe menopause do not need anytests to make the diagnosis. If you areunder 45 years old then hormoneblood tests are usually advisable. Youmay be advised to have blood testssuch as your cholesterol level or

other hormone levels or a DEXAscan which is used to diagnoseosteoporosis.

It is important that you keep up todate with regular smears and breastscreening, if applicable.

your life and can really affect yourrelationships with your partner, familyand work colleagues.

Some women notice that their periodsgradually become lighter and moreirregular. However, others will find thattheir periods become more frequentand heavier.

Some women only experiencesymptoms for a few months. For manyother women their symptoms may lastseveral years. However, for around athird of women symptoms can last formore than ten years.

What are the potential risks to your health from the menopause?

If symptoms are not enough, there areactual health risks to your body when

you go through the menopause.

Osteoporosis

In your body there are cells which areconstantly laying down new bone andother cells which are reabsorbing older,worn-out bone. As you get older thisbalance changes so more bone beingremoved than laid down. This can leadto thinning of your bones, which isknown as osteoporosis. Osteoporosisis much more common after themenopause as oestrogen works tokeep your bones strong, so asoestrogen levels fall the bone lossbecomes more rapid.

Having osteoporosis increases your riskof fracturing (breaking) a bone. This canobviously be painful but can also leadto other problems. Some women withosteoporosis have small fractures inthe bones of their spine, which can bevery painful. Fracturing your hip canreally affect your future quality of lifeand many people lose theirindependence after a hip fracture.

Cardiovascular disease

Cardiovascular disease means diseaseof your heart and blood vessels soincludes heart attacks and strokes. Yourrisk of cardiovascular disease increases

after the menopause as oestrogen isvery important in keeping your bloodvessels healthy.

Other diseases

There is an increased risk ofosteoarthritis, type 2 diabetes and

dementia in some women after theirmenopause.

Hormone replacement therapy (HRT)

HRT is only one type of treatment forthe menopause. It is the most effectivetreatment available to improve yoursymptoms and it can also work toreduce your risk of osteoporosis andcardiovascular disease.

It is a real shame as over the past tenyears or so, HRT has been given anegative press so many women arescared and worried about taking it. Thenegative reports are largely due to alarge trial that was reported in 2002

(called the Women’s Health Initiative(WHI) Study) which has since beenshown to be flawed. It actually studiedwomen who are older (in their 60s)and they were given types of HRT thatwe do not prescribe nowadays.Interestingly, the authors of this studyapologised in a mainstream medicaljournal (NEJM) as they admitted thatpeople misinterpreting the results oftheir study is one of the main reasons

that women are unnecessarily worriedabout taking HRT.

For the majority of women startingtaking HRT when they are under theage of 60 years, the benefits of HRTreally do outweigh any risks. This meansthat it is safe to take HRT and takingHRT can provide you with positiveeffects to your future health, especiallyyour bones and heart.

What is HRT?

HRT is treatment that containshormones. The type of hormones youneed and the doses you are givenvary between each woman. So it is nota “one type fits all” prescription. Alltypes of HRT contain an oestrogenhormone. This replaces the oestrogenthat your ovaries no longer make afterthe menopause.

HRT is available as tablets, skin patchesor gels. There are several brands foreach of these types of HRT. If you stillhave your womb (so have not had ahysterectomy) then you will also needto take progestogen (a type of thehormone progesterone) which isusually given as a tablet and can be incoil. This is because if you just takeoestrogen then the lining of yourwomb (uterus) builds up. This canincrease your risk of developing cancerof the uterus. There is no risk of cancerof your uterus when you also take theprogestogen. In some HRT products,

the oestrogen and progestogen arecombined in the same tablet or patch.

If you are still having periods when youtake HRT then the type of HRT you willbe given will lead to you having regularperiods. If it has been more than a yearsince your last period or you have beentaking HRT for a year then the type ofHRT can be changed to one where youwill not have periods.

Testosterone is another hormone thatwomen produce. Although it is alsothe male hormone, women produce itin lower amounts and it is animportant hormone. Lower levelsoccur during the menopause and cancause symptoms such as poorconcentration, low energy and reducedlibido (sex drive). Testosterone isusually given as a cream which you useevery day. Your menopause doctor willbe able to talk to you about this inmore detail.

Benefits of HRT

The right type and dose of HRT canwork really well to ease the symptomsof the menopause. HRT is a safe andeffective treatment for most healthywomen with symptoms who are goingthrough the menopause. It has benefitsand risks, which are discussed below.The benefits and risks of HRT will varyaccording to your age and any otherhealth problems you may have. You willhave the opportunity to discuss any

potential risks of HRT with your doctorin detail at the menopause clinic.

Taking HRT reduces your future risk ofosteoporosis. Even the low dose typesof HRT provides bone protection towomen. Starting HRT when you areless than 60 years of age also reducesyour risk of developing cardiovasculardisease.

Risks of HRT

The risks of HRT depend on the typeof HRT you are given and also otherfactors such as your age and yourgeneral health. This is why it is soimportant to have an individualisedconsultation where you can discussyour actual risks. HRT can increaseyour risk of developing certainproblems but this increase in risk isvery small in most cases.

Women who take some types HRT astablets have a small increased risk ofdeveloping a clot in their veins or astroke. You are more likely to developa clot or have a stroke if you haveother risk factors for these conditions.These include being obese, having aclot or stroke in the past or being asmoker.

This risk of clot or stroke is not presentfor women who use oestrogen aspatches or gel rather than tablets.Women who have an increased risk of

clots or stroke are usually given thesetypes of HRT.

Many women worry about breastcancer when taking HRT. Some typesof HRT do not increase the risk ofbreast cancer whereas others mayincrease the risk. This increased risk isvery small and is similar to theincreased risk associated with drinkinga couple of glasses of wine each night.There have never been any studiesshowing that taking HRT increases therisk of death from breast cancer.

There is no increased risk (andprobably a reduced risk) of breastcancer if you have had a hysterectomyin the past and are just takingoestrogen without a progestogen.

In addition, there is no increased risk ofbreast cancer in women who takeHRT under the age of 51 years.

www.menopausedoctor.co.uk

There is a wealth of information available to you on the

Internet, in books and in articles on this subject. However,

much of it is out of date, inaccurate and / or misleading!

Our website contains some really useful facts and information.

Side effects of HRT

Side effects are problems that are notserious but may occur in somewomen. Side effects with HRT areuncommon but if they do occur thenthey usually happen within the firstfew months of taking HRT and thensettle with time as your body adjuststo taking the hormones.

In the first few weeks you may evelopa slight feeling of sickness (nausea),

some breast discomfort or legcramps. HRT skin patches mayoccasionally cause irritation of theskin in some women. A change to adifferent brand or type of HRT mayhelp if side effects occur. Variousoestrogens and progestogens areused in the different brands. If youhave a side effect with one brand, itmay not occur with a different one.

• There are more benefits to yourhealth from starting HRT early

• You do not have to wait for yoursymptoms to become severebefore taking HRT

• There is no maximum length oftime for which you can take HRT

• HRT is not a contraceptive• HRT does not work by “delaying

your menopause”

• If you have menopausal symptomsafter stopping HRT then these aresymptoms you would otherwiseexperience if you had never takenHRT

• HRT is beneficial for most women• Taking HRT can give you your life

back!

Other details about HRT

The benefits of HRT have to be balanced against any risks. You have todecide what is right for you, with advice from the menopause clinic,

depending on your individual circumstances.

Dr Louise Newson is a GP and menopause expert who feels passionately aboutimproving awareness of safe prescribing of HRT to ladies at all stages of the

perimenopause and menopause and also about offering holistic treatments forthe menopause.

Dr Newson developed the Newson Health Menopause and Wellbeing Centre inStratford-upon-Avon in 2018.

This centre offers private menopause consultations from a number of female GPsspecialising in the menopause and women’s health. There are also a range of

wellbeing services offered such as nutritional advice, women’s healthphysiotherapy, acupuncture, counselling, hypnotherapy and yoga. The laser

treatment for vaginal dryness, Mona Lisa Touch, is also available.

Dr Newson also provides information and advice about the menopause on herwebsite at www.menopausedoctor.co.uk 

as well as on social media.

Winton House, Church Street, Stratford-upon-Avon, CV37 6HB

Enquiries: 01789 595004 | Email: info@newsonhealth.co.uk | Web: www.newsonhealth.co.uk