The Benefits Of Using Hormone Replacement Therapy (HRT)

How will HRT benefit me?

HRT protects you from a very serious health risk – HRT has a very significant effect on bone health to dramatically reduce the risk of osteoporosis and osteoporotic fracture. This is because HRT:

• Reduces loss of calcium from the skeleton, helps maintain healthy bone strength (bone mineral density – BMD)

• Directly promotes new bone growth

• Prevents the chance of a major osteoporotic fracture by 50%

Fracturing a major site such as your hip is linked to a 20% increased risk of dying. For those who survive, they often lose their independence and report a lower quality of life.

HRT may reduce the risk of heart disease and stroke too:

• Relaxes smooth muscle, hence slightly lowers blood pressure, just a few degrees (but it does not cause high blood pressure)

• Helps maintain the smoothness of arterial vessel walls – important as it is fragments of fatty deposits which can sheer off the vessel wall that give rise to heart attacks and strokes)

• Positively affects cholesterol to increase HDL and lower LDL cholesterol

• Promotes carbohydrate metabolism and is beneficial in diabetes

HRT may also reduce the risk of:

• Colon Cancer

• Rheumatoid Arthritis

• Alzheimer’s Disease

As well as health risks, HRT can also improve the symptoms of menopause, including: 

• The frequency/severity of hot flushes and night sweats – may even get rid of these completely

• Can improve sleeping patterns

• Energy levels – once the hot flushes have gone and are sleep has improved, women have more energy and feel better in themselves

• Helps stabilise mood (although HRT is not an antidepressant) and reduces anxiety

• Relieves symptoms of vaginal dryness

• Improves urinary symptoms

• Reduces the discomfort from painful sex/ in this way can help with general interest in sex/sexual function

• Can improve the condition of skin, hair and nails

• Improves joint pains

• May help dry eyes

HRT needs is most helpful when taken at the right time in your life – for the most part, these benefits are seen in women who use HRT through the menopausal transition, and this time period is called “the window of opportunity.” This means women taking HRT in their 50’s-60’s. This is because, if they do not take HRT through the window of opportunity,  the disease precursors may develop, and by the time take HRT later in life, it may be too late for HRT to have any influence or be more risky to use.

Please note – some benefits that occur while taking HRT are lost when HRT is discontinued.

Is HRT better than a 'natural' menopause?

HRT compared to menopause without treatment:

• Can be much safer

• Improves your life expectancy

• Improves your quality of life

• Reduces symptoms of menopause

A ‘natural menopause’ is a loss of hormone levels – oestrogen production is an essential part of a healthy woman’s body. During menopause, oestrogen levels drop, and this has longer term negative consequences for your health. HRT helps protect you from this.

"Why ‘medicalise’ a natural process women go through?" – the need to ‘medicalise’ menopause comes from the increased health risks associated with it and the fact that not treating them leads to lower life expectancy and quality of life.

Support for ‘natural menopause’ is based on false information – two studies done in the 1990s that mistaken suggested HRT was causing a risk in cancer and heart disease caused widespread panic that resulted in huge numbers of women missing out on HRT treatment. See here for more information.

Which kind of HRT has the most benefits?

Combined HRT has the most possible benefits – this is because it involves treatment with progesterone and oestrogen so you may experience additional benefits alongside your menopause treatment. This can be in the form of:

• Oral tablets

• Patches – these are less likely to cause stomach-related side effects than tablets

• Implants – these don’t require regular use, so they can be more convenient

What extra benefits can combined HRT cause? – progesterone and oestrogen combined treatment can help:

• Reduced risk of some cancers:

• Colorectal

• Ovarian

• Endometrial

• Reduces ovarian cyst symptoms

• May improve acne

Vaginal HRT is the safest – there is less chance of side effects here because it only affects your vagina and not your whole body like patches or oral tablets. It also doesn’t need to include progesterone because it doesn’t affect the womb.

Vaginal HRT also improve vaginal dryness the most – because it’s applied directly to the vagina it can cause the most improvement for this symptom.

Continuous HRT will mean no menstrual bleeding – compared to cyclical HRT, where you have bleeding breaks, continuous HRT means you don’t have to regularly stop and have a menstrual bleed. Not everyone can have continuous HRT though, you must:

• Be aged 54, or,

• Have had no periods for 1 year over 50, or

• Have had no periods under 50 for 2 years

Does HRT have the most benefits compare to other menopause treatments?

Yes, when it comes to relieving the main symptoms of menopause – HRT has been shown to be the most effective way of relieving hot flushes and night sweats. In a 2004 Cochrane review, HRT reduced hot flushes by 75% compared to a placebo. This is a superior response to any other currently available menopausal treatment.

How do I decide on a menopause treatment? – an assessment from a doctor will help you figure out which menopause treatment is right for you. They will assess you on the following:

• What is the indication for treatment? (Often this will be for symptom control)

• Are there any medical reasons why HRT should not be given/used with caution?

• What additional benefits could you expect from using HRT as opposed to any alternative? (For example, bone protection from HRT, which is not the case with any alternative menopause treatments)

• What type of HRT would be preferable – combined/oestrogen only, cyclical/continuous combined, tablet/patch or gel, and which dosage

• When should your treatment be reviewed? 3 months/6 months?

You should initially be assessed for HRT via a face to face appointment (usually with your GP or gynaecologist). If you do start HRT, a follow up consultation should also be arranged to check your progress with the treatment.  Once established on treatment you can fill in a short health questionnaire using our online service and reorder your treatment. Your online doctor will check your assessment and approve treatment if it’s still appropriate for you.

Can I use herbal supplements instead? – buying alternative herbal products/dietary supplements may have no benefits and some potential risks:

• Many of herbal products have been found to contain high levels of heavy metals such as lead, mercury, and arsenic

• You will also not be protected against the health risks of menopause that comes with proper treatment

• If you are buying any alternative treatments for menopause you might be buying from an unregulated organisation that is operating illegally

Does HRT have any downsides?

HRT does come with a risk of side effects – common side effects include:

• Breast tenderness

• Nausea

• Headaches

• Bloating

• Depression

• Irritability

Is HRT right for everyone? – no, HRT treatment is not right for everyone. You may not have HRT if:

• You have the following medical conditions:

• Pregnancy

• Undiagnosed vaginal bleeding

• Recent heart attack (within 6 months)

• Breast cancer

• History of deep vein thrombosis

• History of, or known carrier of, blood clotting mutation e.g. Factor V Leiden, Protein C, Protein S or antithrombin deficiency

• Abnormal liver function with current abnormal liver function tests

• Porphyria cutanea tarda

• Allergy to any of the constituents

• You are already using the following medications:

• Anticonvulsants such as phenytoin, and carbamazepine

• Antibiotics such as rifampicin and rifabutin

• Anti HIV drugs such as ritonavir, nevirapine and efavirenz

• Herbal remedies e.g. St John’s Wort

Why do some people choose not to get HRT treatment?

• “I don’t like the idea of hormones” – hormones are a natural part of your body and in HRT, it’s only bringing your hormone levels back up to normal, it’s not increasing them above that

• “I think menopause is natural and not a medical condition” – however you think about menopause, it doesn’t change the health risks and symptoms associated with not getting treatment

• “I don’t like taking pills” – there are options other than HRT pills, you can try patches or vaginal tablets, or other non-HRT menopause treatments

• “I don’t want to bother the doctor” – national guidelines promote treating menopausal women with HRT when appropriate. Asking a doctor for treatment to improve your health is not bothering them

• “I’m worried about the health risks of getting HRT” – you are much more likely to benefit from HRT than come to harm, as long as its prescribed at the right time and monitored appropriately 

• “I’m happy to try a natural menopause first to see how it goes” – you can do this but remember that you only have a fixed window of opportunity to get treatment for your menopause. Also, you could be putting yourself through the symptoms of menopause unnecessarily

• “Isn’t HRT a temporary fix anyway?” – HRT is ongoing as long as it benefits you and is slowly phased out when it’s right for you. If you have ongoing problems your doctor can extend treatment or help you manage in other ways

Sources

Macdonald, A. (2016). Testosterone implants are available in the UK. Write Health. [online] Available at: http://writehealth.co.uk/testosterone-implants-available-in-the-uk/ [accessed 14th March 2018].

MacLennan, A. H. et al (2004). Oral oestrogen and combined estrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Of Systematic Reviews, Oct.

Rennert, G. et al (2009). Use of hormone replacement therapy and the risk of colorectal cancer. J Clin Oncol., Sep 20; 27(27): 4542-4547.

Welton, A. J. et al (2008). Health related quality of life after combined hormone replacement therapy: randomised controlled trial. BMJ, Aug; 337: a1190.