Hormone Replacement Therapy

The strict definition of the menopause is the last menstrual period that a woman has in her life. However, it is more commonly thought of as the time of life that immediately precedes and follows their last period. This duration can last for several years. The doctor's definition of postmenopausal is when a woman has not had a single period in one year.

The average age of the menopause is 51. An early menopause is one that happens before 45 years of age, and it is known as Premature Ovarian Insufficiency.

Most women experience the menopause between 45-55 years of age. Most symptoms last around four years from the date of the last period, but some women may experience symptoms for 10-12 years.

Some women go through the menopause without experiencing any significant issues, but others will have to deal with symptoms. Around 80% of women will have menopausal symptoms at some point, while around 25% will have very severe symptoms.

Most symptoms are linked to a lower level of oestrogen. Over 50% of women experience menopausal symptoms for longer than seven years.

Short-term menopausal symptoms include:

• Hot flushes: affect around 75% of women and cause flushing of the neck, face, and chest. It is common to sweat and feel weak or nauseous during a hot flush, which generally lasts for a few minutes. You may experience heart palpitations or feelings of anxiety. Hot flushes can occur occasionally, or as many as 15 times per day. They can persist for several years.
• Sweats: most often occur at night. It can be so severe that you are woken up and may need to change your bedding.
• Headaches, sleep problems, depression, tiredness, anxiety, aches and pains, low sex drive and irritability may also develop.
• Alterations to your period, such as shorter or longer times between periods, and other related inconsistencies.

Long-term menopausal changes can affect:

• Skin and hair: due to the loss of collagen after the menopause, you may find that your skin becomes drier, thinner and more susceptible to itching.
• Genital area: lower oestrogen levels can cause vaginal tissue to become thinner and drier. This may mean that your vagina shrinks a little or expands less easily during sex, which may cause pain during intercourse. Your vulva may become thin, dry and itchy, and you may need to pass urine more often. Some women may find that they suffer recurrent urine infections.
• Bones: due to a loss of density and strength of the bones, you may develop a condition known as osteoporosis which makes them easier to break.
• Cardiovascular system: the risk of suffering heart disease or stroke go up after the menopause due to the loss of oestrogen.

The menopause occurs naturally as women age. The ovaries no longer produce eggs and make less of the female hormone oestrogen.

An early menopause can be caused by a number of factors, including:

• Surgery to remove your ovaries, which usually brings on the menopause immediately
• Radiotherapy in the pelvic region as treatment for cancer
• Chemotherapy drugs used to treat cancer
• Surgery to remove your uterus
• Genetics, as an early menopause can run in certain families

In some cases there is no medical explanation for an early menopause.

In most cases your doctor will be able to diagnose the menopause by evaluating your typical symptoms. Younger women may be given hormone blood tests to see if they are going through the menopause or experiencing another health issue.

If your symptoms are not typical you may be given some blood tests or scans.

Some women do not seek treatment for menopausal symptoms, which last for a few years in most cases. Others will be given hormone replacement therapy (HRT) to make symptoms more bearable. HRT carries certain risks which will be evaluated by your doctor.

Other treatments such as herbal remedies are available, but they aren't generally as effective as HRT.

Lifestyle changes are an important part of any effort to manage the menopause.

• Eat a healthy diet that is low in fat, sugar, and salt but high in vitamin D and calcium.
• Cut down on caffeine to reduce the number of hot flushes and sleep disturbances.
• Exercise regularly to combat anxiety, depression and bone weakness.
• Reduce alcohol consumption to fight weight gain and hot flushes.
• Quit smoking to reduce hot flushes.
• It is also a good idea to drink lots of water to keep your body hydrated.

There are a number of things you can try to make menopausal symptoms more bearable. For example, if you suffer night sweats and hot flushes, try to wear light cotton clothing, take a cold shower, use a fan, and/or avoid spicy food.

Women who suffer vaginal dryness could use moisturisers or lubricants, while yoga, meditation, and regular exercise can help with mood changes.

There are also a number of natural remedies that have been used throughout history to relieve menopausal symptoms. Soya and red clover are popular choices, but there is no scientific evidence to prove their effectiveness.

Always consult your doctor if you want to use natural remedies to manage the menopause. This is important because they can interfere with other medication or cause side effects.

HRT comes in different types, all of which contain the hormone oestrogen. It is designed to make menopausal symptoms more bearable by replacing the oestrogen that is no longer produced in your ovaries after the menopause.

HRT is manufactured in different forms, including tablets, gels, skin patches, nasal spray and a vaginal ring. Many different brands are available.

To take HRT you will need to visit your doctor. They will be able to evaluate the suitability of HRT treatment in your individual case, and prescribe treatment if they believe that it will be beneficial.

Always take HRT exactly as prescribed by your doctor. Tablets are usually taken on a daily basis.

Women who start HRT treatment while they are still having periods, or recently finished having periods, are generally advised to take cyclical combined HRT. These tablets deliver oestrogen every day and progestogen for 14 days of every 28-day cycle. This means that there will be a regular bleed every 28 days as the lining of the uterus is expelled from the body.

Those who have taken cyclical combined HRT for a year, or have gone a year since their last menstrual period, will be advised to take continuous combined HRT. This delivers both oestrogen and progestogen on a daily basis.

If you are only experiencing symptoms in the vaginal area, you may want to use a cream, vaginal tablet or vaginal ring to deliver oestrogen.

If you have had a hysterectomy you will only need to take oestrogen.

The amount of time that you use HRT will be decided after a consultation with your doctor. Most women need treatment for two to three years.

If you take oestrogen by itself, the lining of the uterus starts to build up and increases the risk of developing cancer of the uterus. This is why some forms of HRT also contain the hormone progestogen.

Some brands of HRT medication contain oestrogen and progestogen in the same tablet, while others require you to take separate medication. Women who have had a hysterectomy do not need to take progestogen.

Clots in the veins

These blood clots can lead to deep vein thrombosis (DVT) or pulmonary embolism (PE). These conditions are collectively known as venous thromboembolism.

Women who use HRT are at a higher risk of getting a clot. Other risk factors include smoking, obesity and a history of blood clots. Using HRT patches or gels does not present an increased risk of blood clots. Seek urgent medical attention if you notice a red or swollen leg, experience a shortness of breath, or have chest pains.

Breast cancer

Women who use HRT have a slightly higher risk of developing breast cancer. Combined HRT medication presents a higher risk than oestrogen-only HRT. The risk increases over time but there is no increased risk when you stop taking HRT.

The risk is very small, equivalent to one extra breast cancer diagnosis per 1,000 women per year. Most studies show that there is no increased risk for women that use HRT for five years or less.

Other studies show that oestrogen-only HRT doesn't lead to an increased risk of breast cancer, and may even lower the risk.

There may be some misdiagnoses due to the fact that HRT increases the density of breast tissue. This raises the probability of an abnormal mammogram, but this is not the same as breast cancer.

Women under the age of 50 who use HRT have no increased risk of breast cancer.

Stroke

Several studies have reported a small increased risk of stroke in women who use oestrogen-only and combined HRT tablets. However, HRT patches and gels present no increased risk.

Medication that contains lower amounts of oestrogen appears to present a lower stroke risk than those with higher doses.

Cancer of the uterus

Oestrogen-only HRT presents a higher risk of cancer of the uterus in women who have not had a hysterectomy. Combined HRT reduces this risk completely.

Cancer of the ovary

Studies suggest that both forms of HRT slightly increase the risk of ovarian cancer. This risk drops after you end HRT treatment.

Other factors

Women with liver disease, porphyria, untreated endometrial hyperplasia or an allergy to HRT should not use HRT.

It is important to remember that HRT is one of a number of risk factors for these complications. Smoking, obesity, diet and family history all play an important role.

side effects of HRT

Side effects are generally not serious but may affect some women. These effects may include leg cramps, breast discomfort or slight nausea. Skin patches may cause irritation, and tablets may cause headaches or migraines.

If you experience side effects it may be recommended to try a different brand of HRT treatment.

Doctors recommend HRT for the treatment of short-term symptoms. Take the lowest dose possible and always tell your doctor about any changes to your health.

Remember that HRT is not a contraceptive. Keep using contraception until two years have passed since your last period if you are under the age of 50, or one year if you are over 50.