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Menopause is the phase in a woman’s life when her menstrual cycles end or the periods stop. It is a normal part of ageing. During the last years before menopause and menopause, the hormonal levels either go too high or too low in the women, which can lead to conditions such as vaginal dryness. To overcome these problems, few women undergo HRT, i.e. hormone replacement therapy.
Although HRT is the best solution for getting relief from menopausal symptoms, it is not completely risk-free. Knowing the pros and cons of the therapy can help women judge their need for undergoing HRT.
Which hormones are included in HRT?
Oestrogen and progesterone are the two hormones which play an important role in women’s bodies. A fall or rise in the levels of these hormones can cause a range of emotional and physical disturbances in women. Oestrogen helps the ovaries to release eggs, regulates the menstrual cycle and helps in conception. It also controls skin temperature, keeps the vagina moist, and maintains the bone density. Progesterone prepares the womb during pregnancy. A fall in the level of progesterone does not have similar kinds of ill effects as with oestrogen. However, if oestrogen alone is given during HRT, it increases the risk of womb cancer. Therefore, progesterone is also given in combination with oestrogen during the therapy. In the case of hysterectomy (where your womb is surgically removed), only oestrogen is given during HRT.
How is HRT available?
HRT can be taken in different forms including tablets; patches that are attached to your skin; implants which may be inserted under the skin of the buttock, tummy or thighs; and gel which can be applied to the skin for absorption of the hormone. Your doctor will suggest the right dosage form for you.
Benefits of HRT
The major benefit of HRT is that it can effectively control the symptoms of menopause and is approved for this use. The quality of life of the woman is significantly improved. The other benefits of the therapy are:
- The risk of developing osteoporosis (a bone-thinning disease) is reduced with HRT. The muscle function also improves in women on HRT.
- The risk of cancers such as colon or rectal cancer is lowered.
- Females who received this therapy soon after their menopause had a significantly lowered risk for heart attack or heart failure.
- The mortality rates are also found to be lower in women who received HRT after their menopause.
Who should consider HRT?
You may consider undergoing HRT if you have:
- lost bone mass and are not benefitted or tolerant to the other treatments.
- premature menopause (i.e. stopped periods before the age of 40 years) or your ovaries stopped functioning normally by the time you have turned 40. HRT is not advisable for women who have crossed 60 years.
- experienced menopausal symptoms or moderate to severe hot flashes.
Risks associated with HRT
The possible side effects of HRT include a headache, indigestion, bloating, breast tenderness, fluid retention, and depression. Other risks include the following
- Discontinuation after prolonged therapy with HRT can lead to a rapid decrease in bone density.
- The risk of deep vein thrombosis (blood clots in the vessels of legs), and pulmonary embolism (blockage in the arteries supplying the lungs) is also high with HRT.
- Combination therapy (oestrogen plus progesterone) has a slight chance of certain cancers such as breast cancer, ovarian cancer or womb cancer.
Factors such as your age, the time since you had menopause and the time at which you had menopause significantly affect the outcome with HRT. If you have experienced early menopause, then the benefits of hormonal replacement therapy outweigh the risks.
Generally, the benefits outweigh the risks if the therapy is given for a short term (less than 5 years). You should discuss the risks especially if you have undergone long-term therapy (for more than 10 years).
How to reduce the risks with HRT?
Talk to your doctor regarding the following strategies:
- Which product and delivery method is best for you? Estrogen is available either in the form of pills, gel, patches, vaginal cream, or a slow-releasing suppository. For example, if you only have vaginal symptoms, then a low dose of a vaginal cream or tablet or a ring is better for you rather than pills or skin patches.
- Minimise the medication dose. Use that dose which is effective for you even when used for a short duration. Your doctor may recommend long-term therapy in case your menopausal symptoms are long-lasting and impair your quality of life.
- Follow up with your doctor regularly to ensure that the benefits of the therapy outweigh the risks, along with getting certain screening checkups such as pelvic exams and mammograms.
- Lifestyle changes can also help you to reduce the risks associated with the HRT. Exercising regularly, maintaining a healthy body weight, following a healthy diet, limiting alcohol intake, managing stress, and avoiding tobacco are the changes you need to implement.
Who should avoid hormone replacement therapy?
Women who have breast cancer (either active or a history), endometrial cancer, ovarian cancer, stroke, or blood clots in the legs or lungs, should not take HRT.
Other approaches if HRT is not suitable for you
You can manage the menopausal symptoms by alternative approaches if HRT is not safe for you
- Practicing breathing techniques or other relaxation methods.
- Cutting down on caffeinated drinks, alcohol and beverages.
- If you have vaginal dryness or pain during intercourse, then vaginal lubricants or moisturizers can be of great help. You may ask your doctor to know which method works effectively for you.
Hormonal replacement therapy is not good or bad. Discuss with your doctor the risks and benefits of HRT which are specific for you. Only your doctor can suggest if you can undergo the therapy or if you should choose any other alternative options.
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