Here’s What You Need to Know Before You Start HRT

Many women dread menopause. Maybe you’ve been told horror stories about hot flashes, night sweats, migraines and loss of libido. Your mother or sister or friends have warned you that it might go on for years and years. Menopause starts to sound awful, so you begin to consider hormone replacement therapy (HRT). But then you read that HRT will give you cancer, or that you’ll be given artificial hormones instead of natural ones. What should you do? Of course, the decision is yours, but here are some facts to help you make up your mind.

Menopause (technically perimenopause, that is, the time leading up to and following on from your final period) is different for every woman. It’s a natural process, not an illness. Some women sail through midlife with hardly any issues. Some women have mild symptoms for a short time. Some do have distressing symptoms, but there’s no way to predict how bad they’ll be or how long they’ll last. So until symptoms actually occur, there’s no point worrying about it.

Stress will make things worse. Menopausal symptoms such as headaches or low sex drive are made worse by tiredness or anxiety. The fact that they can occur when many women are getting nearer the top of the career ladder, dealing with teenage children and possibly caring for elderly parents is a significant factor in how bad things can be. Exercise, meditation, a healthy diet and perhaps some therapy can be as beneficial as taking hormone replacements.

HRT was widely prescribed from the 1960s and 70s. In the 2000s two large-scale studies reported that women using HRT were more likely to develop breast cancer and heart disease. Media coverage suggested that women had a choice between experiencing distressing menopausal symptoms or risking a painful early death. But in the past few years follow-up studies have found that although there are some risks, death rates among women who took HRT are not significantly higher than among those who didn’t. To put it into context, being overweight is four times more likely to be associated with developing breast cancer than using HRT.

Because there are still risks involved, you shouldn’t start HRT if you have a history of breast, ovarian or womb cancer, if you have untreated high blood pressure or a history of blood clots, or if you have liver disease. If your doctor decides that HRT isn’t suitable for you, ask about alternative treatments.

There are lots of ways to take HRT medicines – you can take pills (like the contraceptive pill), use creams or patches, pessaries or have a slow-release implant. What these all have in common is that they contain hormones to replace the ones your body no longer produces. These hormones, like all approved medicines, are produced in laboratories with strict quality control measures. Some women want to take “bio-identical” hormones, believing them to be more natural. There’s no clinical evidence that bio-identical hormones are more effective or less harmful than other HRT products, and they do pose a risk of over- or under-dosage.

HRT isn’t a miracle cure. Your doctor will start you on a very low dose and will only increase it if your symptoms don’t improve in the first few months. You should expect it to take at least three months, and possibly up to a year, to find the dosage and delivery method that’s right for you.

Many women expect that menopause will be a difficult time, but that might not be the case. However, if your perimenopausal symptoms are distressing, you can use HRT without feeling that you’re taking unnecessary risks. You can talk to Dr. Wendy Scinta about your experiences and your needs, and be prepared for a certain amount of trial and error to find the right solution for you. And remember that exercise, eating healthily and dealing with stress will make a huge difference too.