October 16, 2022

In part two of our Optimise Your Age conversation supporting World Menopause Day (October 18th) below, menopause expert and Women’s Health GP, Dr Elise Dallas has been sharing what you need to know about HRT and why you shouldn’t fear it.

HRT (hormone replacement therapy) 

Despite some bad press over the years, I can reassure you that HRT is the safest and most effective way to help women through menopause. During the menopause oestrogen levels naturally fall, HRT tops up these declining hormones and relieves symptoms caused by their decline.  HRT can be taken as tablets or through a patch or gel on your skin. If you still have a womb you will take ‘combined HRT’, which contains oestrogen and progesterone. If you have had a hysterectomy, you just need to take oestrogen. It has been shown that if HRT is started within 10 years of the menopause that the benefits outweigh any risks.  

So what are these risks and benefits of taking HRT? 

Hormones impact the whole body (and not just your menstrual cycle), so the implications of having a low oestrogen for a third of your life can be significant. Taking HRT can help manage menopausal symptoms you may be experiencing now, but importantly it also has long-term health benefits, such as significantly reducing your future risk of cardiovascular disease, osteoporosis and type 2 diabetes.  

Does HRT increase my risk of getting breast cancer, blood clots and strokes?  

This is a really important question and I understand why this may be on your mind. The risks are usually very small and depend on the type of HRT you choose, how long you take it for and your own health risks.  

Breast cancer risk:  

  • There is little or no change in the risk of breast cancer if you take oestrogen-only HRT 
  • Combined HRT (oestrogen and progestogen) may be associated with a small increased risk of developing breast cancer but micronised progesterone has been shown to be the safest. The increased risk is related to how long you take HRT, and it falls after you stop taking it 
  • Women under 51 years do not have a greater risk of breast cancer when taking HRT 

Blood clots: 

  • Oral oestrogen can very slightly increase your risk of blood clots, however, there is no increased risk with transdermal oestrogen (patches or gels) 

Heart disease and strokes: 

  • When HRT is started before the age of 60, it does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) and in fact may actually reduce the risk 
  • Oral oestrogen is associated with a slight increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, meaning the overall risk is still small. Transdermal oestrogen does not have this risk.  

Seeing the risks above it has been shown that the optimum regime of HRT is transdermal oestrogen (patch or gel) with a micronised progesterone or hormonal coil (which has the added benefit of contraception). It is best to speak to a doctor who is aware of the risks and benefits and the latest evidence so you can come up with an HRT regime that is right for you. 

Is vaginal oestrogen the same as transdermal oestrogen?  

No it is not. Vaginal oesterogen is to relieve genitourinary symptoms of menopause, which can affect up to 90% of women and can often be very distressing. It can include dry or itchy vulva and vagina mimicking thrush and / or recurrent urine infections, which can cause painful penetrative sex. The good news is that this estrogen is in such low doses that it does not carry any of the risks above and can even be given to those with breast cancer. This HRT has recently been approved to be sold over the counter and is very safe.

I have heard of foods that contain natural estrogen - can I manage with this instead of HRT? 

Phytoestrogens are plant-based agents that naturally imitate estrogen in the body, they include tempeh, tofu, miso, edamame, flaxseeds, legumes like chickpeas, lentils, red kidney beans and split peas, cruciferous vegetables, such as broccoli, cauliflower, cabbage, and Brussels sprouts, dried prunes, apricots, and dates as well as grains including rice, oats, barley, quinoa, rice bran, rye, and wheat bran. There are some studies that have demonstrated that consuming these foods can moderately support the reduction of menopausal symptoms, like hot flushes and night sweats. However, the amount that gets into the bloodstream is not enough to replace the estrogen and therefore you do not get the other benefits of estrogen replacement such as improvement in long term health. You also must remember that bioidentical oestrogen and progesterone in HRT comes from yams and is identical to our own body - so you can’t get more natural than that! 

How do I know if HRT is right for me? 

Initiating HRT can feel like a big decision and a doctor will talk through the risks and benefits. If you decide to go ahead with treatment, you can usually begin as soon as you start experiencing menopausal symptoms and will not usually need to have any tests. Doctors often suggest a three month initial course and you will soon know whether your symptoms are due to perimenopause, as they should start to reduce after treatment has started. It is not dangerous to try HRT as long as you have no contraindications. Menopause may feel like a great unknown but with good support, knowledge and treatment which works for you, it can be part of a whole new chapter of your life.

We hope you have found our conversation with Dr Elise Dallas helpful. Later in the month we’ll be sharing her thoughts on what lifestyle changes you can make to optimise your health during and after the menopause!

Take care

Sally & Jon