Menopause Series 2-How Long Should You Be on HRT? Lets Look at Benefits/Risks and Relevant Studies

You know how it works….you’re on HRT for a few years and most women seem to try to wean themselves off it. Some succeed and find that they have no more menopausal symptoms after a few years on HRT. Others race back to continue as life feels unbearable without it. After some years, most GPs will try to get you off HRT due to all the risk factors involved.

 

So how long can you really be on HRT?

The short answers are….

  • Regular HRT- its complicated!
  • Bioidentical HRT- for life if it were up to me (and other like minded practitioners)

 

Regular HRT

Its complicated in this instance as HRT as a whole, have many beneficial effects, besides easing of common menopausal symptoms. It then becomes a decision where you have to weigh the benefits that it proffers versus the complications that it can give rise to. These ratios are interesting as when one looks at mortality charts, the biggest ‘scare’ ie breast cancer for most women using HRT. However, according to studies, the risk is only 0.08% for every year of use. This is in fact very low. This is then compounded by the WHI reports that stated that heart attacks went up by 29% and strokes by 41%. This is what was reported in the media and it sounds incredibly scary. But a breakdown of what these numbers actually mean is this:

  • 29% heart attacks: It means that per 10,000 person-years, there would be 37 women who used hormone therapy compared with 30 women who used placebo who would have a heart attack. 7 more women out of 10,000 in a year.
  • 41% strokes: 29 cases of stroke in the hormone group vs 21 in the placebo group per 10,000 person-years. Again, only 8 more women in 10,000. (2)
  • Of course these statistics still does not sound great but at least its not 41 out of 100 women or 29 out of 100 women- which is what we were led to believe!

However, it failed to take into account that a large number of people on the study ranged from 50 to 79 years, with a mean age at initial screening of 63.2 years. 66.6% of the women in the hormone group were between 60 and 79 years. It also failed to take into account that many of them had pre-existing diseases and were overweight (BMI>28.5) which would have made them not eligible for that particular hormone combination. Also, there is not a ‘one size fits all’ for hormone replacement in women. (2)

It also failed to highlight all the benefits HRT gives to these women. (1)

Let’s list the advantages

  • Better quality of life
  • 37% reduction in colon cancer (according to that study)
  • 34% decrease in hip fractures (according to that study)
  • Improved cognition and protects against Alzheimer’s disease
  • Improved balance
  • Improved skin
  • Decreased in urinary tract infection and degeneration
  • Better protection for heart disease and stroke (for the right patients when commenced at the right time)
  • Decrease in osteoporosis or thinning of the bone
  • Protects against cataract and macular degeneration

Very importantly, there is no acknowledgement of the fact that something quite contrary to what our bodies consider to be ‘self’ is being used- ie, a non bioidentical compound. In the WHI study, it was Prempro (0.625 mg conjugated equine oestrogens and 2.5 mg medroxyprogesterone acetate)- read- that is oestrogen from a pregnant mare. Why would or should we assume that our bodies will like them?

 

In summary, if you are on ‘regular’ HRT, please take the trouble to understand what you are taking. It has so many benefits, especially when started very early, when menopause first starts. If you have pre-existing diseases or habits eg obesity, smoking, family history etc, with the right practitioner and changes in lifestyle, its still very much a possibility to continue with HRT. At some point though, especially if its really making a difference to your lifestyle, bioidentical is always better.

             

Citations

  1. Women's Health Initiative Study

  2. Why Individualizing Hormone Therapy Is Crucial: Putting the Results of the WHI Trial Into Perspective

Series 1: Menopause and HRT- an Overview

In this menopause series, I will talk about menopause; what’s done in the NHS, long term implications of HRT, look at some scientific papers and explore your options. This will be over a few blogs that I hope to cover over the next few months.

 

There are a few ways to look at menopause. Some people are simply glad that they don’t have to deal with the ‘dreaded’ monthly bleed anymore. Others take it harder as a sign that they are now officially ‘old’ (although menopause seems to happen earlier these days, as early as late 30s for some, in those with no ovarian failure). Mostly, I find that women are able to laugh with other women about it; sharing their hot flushes over a cup of tea….

For a lot of women, menopause wouldn’t be so bad if it weren’t for the accompanying signs, symptoms and constant reminder that its actually happening. The hot flushes, the night sweats, palpitations, vaginal issues like dryness or itching, libido issues like loss of libido, discomfort and/or pain during sex, foggy brain, changes in mood, insomnia amongst other things.

It also tends to happen at a point in life where things have finally settled down- you know yourself, kids have left home or you’ve (sort of) figured them out, your personal and professional progress is at a point where there’s an element of predictability. This is undoubtedly a generalisation but on the whole, its a period in life when things seem predictable in a good way. Then menopause comes along to shake things up a little.

In my opinion, the lucky ones get all the symptoms. If I had a pound for everytime I hear women commenting on how ‘lucky’ they have been as there had been no symptoms of menopause, I’d be fairly rich. I suppose it is lucky in some ways but I consider symptoms to be a cry for help for the body and also a cry for women to take action. Today, where there are many things that can be done, its not a bad thing.

So what can one do about it?

  • The traditional way to deal with it ranges from natural, plant based supplementation to HRT that your GP prescribes for you.

  • You are told to avoid ‘trigger’ factors like spicy foods, coffee etc.

  • You are advised to eat better, including foods that contain phyto-oestrogens (plant based oestrogens like soy), increase your calcium intake due to potential and probable bone loss and get more sun (Vit D for bone).

  • You’re also told to exercise more.

Does it work?

  • Whilst much slower and subtle with herbs and supplements, it does make a difference. The difference is enough for some but not good enough for others.

  • NHS or regular HRT definitely works but there are a few problems surrounding it. If you have a sympathetic and experienced (in HRT) practitioner, you will probably get a prescription of HRT. They will probably want you to be on it for the least amount of time possible due to potential long term complications like breast cancer and clots. I will go into more depth in a future blog post.

  • Lifestyle changes will certainly make you feel better overall.

 

Then why does it still feel like this is an unresolved issue, with women still attempting to find answers as to what to do, despite all the advancements within this field?

Stay with me on future blogs and we will explore this further.

 

Should We Mess with Nature and "Manage" Ageing?

chicken don't mess with nature.jpg

This is a question I asked myself time and again and now that I'm practising "age management", I get asked this all the time.

Shouldn’t we just embrace ageing? What’s wrong with wrinkles, slowing down, midriff fat, saggy skin etc- everyone goes through it so why shouldn’t we?

My answer to that are more questions:

  • If your hearing goes off- its nature, why bother with hearing aids?
  • If you eyesight goes- why bother with glasses?
  • If you have a blocked artery, why bother with a bypass?
  • Age-related cancers- its the circle of life keeping everything in check isn't it?
  • If you’re hypothyroid, should you supplement with thyroid hormones?
  • if you’re menopausal or andropausal, should you bother?

 

My point is that we already mess with nature. In the things we eat everyday, to cleaning products to medicine. Just look closely enough and you’ll see it everywhere. Why should we allow age related diminishment in hormones in our body-hormones that make us feel like we’re 20 again- affect our quality of life? Doesn’t it simply make sense to replace something that’s missing?

Of course there's also the rather delicate point of asking a 20 year old if he'd like to manage his health span and live to be 90, then putting the same question to an 85 year old. Perspective makes all the difference. The young person could very well say that the older generation needs to make way for the younger generation but when the boot is on the other foot, the answer can be anything.

Perhaps you choose to compare yourself to someone living in say, the Amazon, not exposed much to civilisation but doing very well physically- after all he’s not taking a whole bunch of supplements and he’s fitter than most. Not a good comparison I say. His diet is not ‘industrialised’ (more on diet in another blog post) meaning less harmful substances that lead to modern day illnesses and disease. He also has a very active lifestyle, good familial and community support, less stress and lots of rest. Of course its not all roses for him and I certainly choose my way of living despite the shortfalls. Especially now that I have the tools to make informed choices and decisions.

So should we mess with shortfalls in nature? There is no right or wrong answer to that but I know what I choose and what I want for my family. I’ll leave that to you to ponder.....