HOW CAN HRT HELP WOMEN?
THIS YEAR, THE GOVERNMENT HAS BEEN URGED TO MAKE HRT FREE FOR WOMEN IN ENGLAND
Hormone replacement therapy (HRT) relieves symptoms of the menopause by replacing hormones that are at a lower level leading up to and during the start of the process. Women usually start to experience the menopause between the ages of 45 and 55. During the menopause, the ovaries stop releasing eggs, and levels of the hormones oestrogen, progesterone and testosterone drop, which often causes symptoms such as hot flushes, night sweats, vaginal dryness, reduced libido, disturbed sleep, poor concentration, mood swings, anxiety and brain fog. During the perimenopause – the period leading up to menopause – a woman can suffer from these symptoms, but still have her period.
For many, the effects of perimenopause and menopause can be challenging, but for others they can be debilitating. HRT can help alleviate symptoms, but some patients are nervous about taking it, in part due to bad press following a couple of studies from more than two decades ago. In 2002, a study published in the Journal Of The American Medical Association claimed that taking HRT increased the risk of stroke, breast cancer and coronary heart disease. The next year, another study claimed HRT had caused 20,000 more cases of breast cancer over 10 years.
Since then, doubt has been cast on both studies’ methods, while subsequent research has shown that lifestyle factors, such as diet and alcohol consumption, carry a greater risk for breast cancer.
“Obesity, alcohol intake of more than two units a day, or a late menopause all carry a greater risk for breast cancer than HRT itself,” says Dr Edward Coats, consultant gynaecologist and reproductive medicine specialist. “We are still recovering from the 2002 study, which had a huge dataset, but was flawed. A generation of women have avoided HRT due to worries over increased risks. Menopause experts are looking at how to regain patient trust and communicate the risks and benefits.”
“Diet and alcohol consumption carry a greater risk for breast cancer than HRT”
Indeed, for many women, the benefits of taking HRT outweigh any potential risk. Aside from easing menopause symptoms, HRT increases bone density, preventing hip and spine fractures. Even when the dose is low, these benefits remain for many years after stopping HRT. In women aged between 50 and 59, HRT reduces the risk of cardiovascular-related deaths, and does not increase the risk of heart disease or stroke. There is also good evidence that HRT reduces the incidence of bowel cancer.
However, there are a few conditions – endometrial cancer, breast cancer and venous thromboembolism (VTE) – where HRT may do more harm than good. It depends on the patient, so it is important to get specialist advice about the risk factors for these conditions. There are different types of HRT, and it can be administered in various ways, so women can work with their doctors to find what will be best for them.
“Deciding whether to use HRT is about understanding risk – and this is where it differs for different people,” says Coats. “For the average person, there are more benefits than there are risks.”
In October, the All Party Parliamentary Group on Menopause, which is made up of MPs, called on the government to support women going through the menopause. The group asked for all women to be invited for a menopause check-up when they turn 45, for updated menopause training to be provided for GPs and other healthcare professionals, and for the removal of prescription costs for HRT in England (in line with Scotland, Wales and Northern Ireland).
“A health check for women aged between 45 and 50 would be very useful,” says Coats. “The problem is funding, as currently there are limited resources and rationing of healthcare. However, it is really important that women have access to information about the menopause and treatment options available to them.”