Choosing how to manage menopausal symptoms is a very personal decision and the management options available will depend on a woman’s personal preference, past medical history and family history. Whether or not she opts for the hormonal route should be an informed choice.
The benefits of HRT
HRT has had much bad press over the past decade, and I aim to clarify the true risks according to the latest evidence. The studies that spawned the HRT backlash some years ago were flawed in their choice of subjects and interpretation of results so should not be used now as a guide to risk. More recent studies have shown HRT to be far safer and actually beneficial in most users.
HRT when started in the perimenopause and menopause has been shown to offer a number of health advantages. It protects against osteoporosis, a leading cause of morbidity and mortality in post-menopausal women. It lowers the risk of Alzheimer’s disease, cardiovascular disease and stroke. It helps maintain muscle mass and improves metabolic disorders such as high blood pressure and high cholesterol . It has also been shown to reduce the risk of other cancers including bowel cancer.
Importantly, using HRT has been shown to reduce mortality overall.
The risk of breast cancer is a concern for most women. At the moment we understand there to be a small increased risk of breast cancer when oestrogen is taken in combination with progesterone. This increased risk is the equivalent to drinking a glass of wine every evening and similar to the increased risk by taking the combined oral contraceptive pill.
The risk increase is equivalent to the risk decrease if a woman exercised for 2 and a half hours per week.
Being obese increases the risk of breast cancer by 6-fold.
Another important message is that there is no increased risk of dying from breast cancer if you take HRT.
The benefits of healthy living
As well as HRT there are a number of lifestyle factors that influence menopause symptoms.
Increasing exercise is the number one positive lifestyle change we can make. It has so many proven benefits. Menopause can cause weight gain and in turn a worsening of symptoms. Exercise can reduce that by resulting in weight loss, fat reduction and improving muscle bulk and strength. . The endorphin ‘feel good’ hormone is released after exercise which helps improve mood, decrease stress and anxiety and improve sleep quality and quantity, all of which are worsened at the menopause.
Exercise reduces cancer of risk. It reduces breast cancer and can negate the small increased risk that taking HRT causes, but also reduces the risk of many other cancers. It is excellent for metabolic health it lowers blood pressure, cholesterol and improves sugar control.
Menopause causes bone thinning and impact exercise has been shown to reduce this by strengthening bones muscles and joint stability.
Alcohol can feel like a good idea when the symptoms of menopause include anxiety and insomnia. However, relying on alcohol to treat these symptoms can actually make them worse and should be reduced or avoided.
Can I see my doctor during lockdown?
COVID has brought with it some very unusual times. Access to GPs may be restricted and face to face appointments are not permitted except in emergencies. Some doctors are running emergency lists only. It is very important that women have access to their HRT as a necessary medication. Please do ask your GP for repeat prescriptions and you should be granted them. I use a pharmacy that arranges for next day delivery of HRT. New consultations are by way of video link and have been very successful. My consultations run in exactly the same way as they would had we been face to face and prescriptions and blood tests can be done remotely so women can continue to benefit from the menopause care they need.