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Is HRT Really Necessary For Menopause?

Is HRT Really Necessary For Menopause?

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Hormone replacement therapy is considered the treatment of choice for women experiencing symptoms of perimenopause and menopause, but many women are still hesitant about hormone therapy. We ask our expert, Dr Harpal Bains – is HRT really necessary for menopause?

When it comes to menopause, patients’ experiences vary widely. For some women, it affects them significantly and they can’t function at all. To the other extreme, we see women who sail through menopause and it’s a breeze – they feel perfectly fine and don’t notice any changes. So some others, especially those who have always suffered from bad PMS or painful periods, or bleed so heavily that they are anaemic; menopause becomes a respite and gives them a chance to feel normal again.  And of course, we see women with everything in between.

There is a lot happening in the body throughout this transition period. When your ovaries are producing less oestrogen, ovulation becomes intermittent and eventually, stops. This change happens gradually, and as the oestrogen levels deplete, some women will experience symptoms associated with perimenopause. Perimenopause can last anywhere from one to six years. But the transition to menopause isn’t just about hot flushes and no more periods. The effect oestrogen – or the lack thereof – has on the body goes much deeper than that.

Oestrogen is essential for many functions in the body and contributes to overall wellbeing and quality of life. It’s essential for maintaining bone health, brain health, cardiovascular health and skin health.

Dr Harpal Bains says: “I think that the women who are affected by menopausal symptoms are, in some ways, lucky. Although the symptoms are not pleasant, it’s like your body’s way of telling you what it needs. And women who have symptoms will usually seek out solutions, inadvertently reaping the long-term benefits of hormone replacement therapy.”

Simply put, a woman that isn’t on HRT will likely start to experience more health problems as she ages. A woman who is on hormone therapy will have better bone, cardiovascular, brain and skin health compared to a woman that is not.

“Whenever I talk to my patients about it, I tell them that as far as I’m concerned, the symptom relief part of hormone therapy is a bonus. What I really try to achieve for my patients is maintaining the bone, brain, skin and cardiovascular system to give them a better quality of life. To me, that is why women should have HRT – not just because of menopausal symptoms. The skin should also not be underappreciated as our skin is usually the first organ that tells you something is wrong. When your skin starts to look bad, you have to question why.” adds Dr Bains.

Oestrogen is essential for many functions in the body and contributes to overall wellbeing and quality of life. It’s essential for maintaining bone health, brain health, cardiovascular health and skin health.

Dr Harpal Bains says: “I think that the women who are affected by menopausal symptoms are, in some ways, lucky. Although the symptoms are not pleasant, it’s like your body’s way of telling you what it needs. And women who have symptoms will usually seek out solutions, inadvertently reaping the long-term benefits of hormone replacement therapy.”

Simply put, a woman that isn’t on HRT will likely start to experience more health problems as she ages. A woman who is on hormone therapy will have better bone, cardiovascular, brain and skin health compared to a woman that is not.

“Whenever I talk to my patients about it, I tell them that as far as I’m concerned, the symptom relief part of hormone therapy is a bonus. What I really try to achieve for my patients is maintaining the bone, brain, skin and cardiovascular system to give them a better quality of life. To me, that is why women should have HRT – not just because of menopausal symptoms. The skin should also not be underappreciated as our skin is usually the first organ that tells you something is wrong. When your skin starts to look bad, you have to question why.” adds Dr Bains.

Menopause is natural – shouldn’t women just put up with it?

In the past, our average life expectancy was around 40 years of age – humans usually died from infections and not many women experienced menopause. But today it’s a very different story.

Dr Bains comments: “Some women feel very strongly about not seeking medical treatment for menopause, preferring natural options. Whilst, yes, you can do everything naturally, I’m inclined to ask: What is natural? When oestrogen levels drop and you start to lose bone density – is that natural? Are you okay with losing bone density and having a higher risk of broken bones because it’s natural? Osteoporosis is crippling and affects thousands of us each year. As oestrogen declines and bones lose their strength, even a minor bump or fall can result in fractures or broken bones. I did a lot of orthopaedics in my NHS days and so feel quite strongly about this. As surgeons, we had nothing much to offer them besides fixing the broken bone; knowing very well that the likelihood of seeing these patients again was very high. Hormone replacement therapy is a chance to be proactive and do something that can protect against that.”

Women who prefer natural mechanisms for dealing with menopause can try using evening primrose oil, DIM, and increasing soy intake. This can be combined with clean eating – a whole foods-based diet containing mostly vegetables (pesticide-free) with a moderate amount of good quality meat. But this will only help up to a certain point.

Why are women so hesitant about taking HRT?

Despite the benefits, many women are hesitant about hormone therapy, particularly around the risk of breast cancer. The messaging from the media – and even from some doctors – is that HRT is going to give you cancer. But headlines frequently sensationalise research statistics and present them in a way that will attract the most attention, which can be very misleading. The truth is that the risk of breast cancer with HRT is exceptionally small and the benefits are usually outweighed by the risk. This is a really interesting article from the British Menopause Society about understanding the risks around breast cancer and how findings can be skewed in the media.

A 2019 The Lancet paper reported that out of 50 women (between ages 50 and 69) without HRT, 3 women would be expected to develop breast cancer. For women taking synthetic estrogen and progesterone daily, this would increase by 1 to 4 in 50.

Dr Bains explains: “The research that shows an increased risk of breast cancer has been based on research into Premarin, a synthetic hormone which is derived from a pregnant mare’s urine. And why wouldn’t you expect problems when you’re replacing them with ones that are different to what we have in our bodies? At Harpal Clinic we use bioidentical hormones that have the exact same molecular structure as those in the human body. And I certainly haven’t come across any studies that link these bioidentical hormones to breast cancer.”

Should women have BHRT for menopause?

Dr Bains comments: “People seem to be scared of hormones beyond the age of 40, but just look at all the hormonal problems we have before that age: Endometriosis, PCOS, low fertility, amenorrhea, menorrhagia fibroids – they’re all inflammatory conditions caused by hormones being unbalanced. That, to me, is scarier than having a really controlled, bespoke treatment tailored to you. Not only is hormone therapy safer, but there is also study after study demonstrating all the ways it protects the body. Should women have HRT for menopause? In my opinion, absolutely. It’s fantastic for long-term health and if it helps with symptom-control, that’s a bonus.

“That being said, there is no right or wrong, it’s about what is right for the individual, and making a personalised choice.”

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