Hormone Replacement Therapy (HRT) remains an area of ongoing research and debate amongst experts. According to nhs.uk, while there are risks, most experts now agree that if HRT is used on a short-term basis for no longer than 5 years, the benefits outweigh the risks. Furthermore in November 2015, NICE, UK, issued the first guideline on diagnosis and managing menopause, which provides clarity for both healthcare professionals and women on the benefits and risks associated with HRT.
HORMONE REPLACEMENT THERAPY UPDATES
June 2017: The North American Menopause Society’s new position statement on the use of hormone therapy (HT). NAMS has clarified the position to a more fitting concept of appropriate dose, duration, regimen and route of administration. Individualised evaluation and discussion between women and their practitioner is recommended.
March 2016: A team at Imperial College, London, have developed a new drug called AZD4901 for the treatment of hot flushes without raising the risk of breast cancer. The drug works by blocking a brain signal that triggers hot flushes. Dr Julia Prague of Imperial College noted “if all goes well, we would be very hopeful it could be in routine clinical practice within five years, with GPs able to prescribe it instead of HRT”. This is great news for women who suffer no other menopause symptoms apart from hot flushes.
February 2016: The American College of Obstetricians and Gynecologists supports the use of vaginal estrogen for breast cancer survivors who are unresponsive to non-hormonal-remedies.
November 2015: NICE (National Institute for Health and Clinical Excellence) UK, issued the first guideline on diagnosis and managing menopause. You can find the guideline for professionals and a simplified version for women patients here.
October 2015 – HRT Guidelines Favor Individual Approach to Menopause
New guidelines for the treatment of menopausal symptoms are given the green light to HRT for carefully selected women at low risk for cardiovascular disease (CVD) and breast cancer who are eager to take HRT due to their symptoms. This latest advice was published online October 7, 2015 and will appear in the November issue of the Journal of Clinical Endocrinology and Metabolism.
“We have to be mindful of the individual health concerns of our patients and first ask: ‘Is HRT going to be safe for her to take?’ ” Cynthia Stuenkel, MD, from the University of California, San Diego and task force chair of the new guidelines, said during a virtual press conference. Dr Stuenkel emphasised that women are eligible for HRT if they are no more than 10 years into menopause.
The two main symptoms the Endocrine Society’s new guidelines specifically target are vasometer symptoms (hot flushes/flashes/night sweats) and genitourinary symptoms (vaginal dryness or discharge, pain, burning or itching, urinary frequency, recurrent urinary tract infections. “The most effective therapy for both sets of symptoms is HRT,” Dr Stuenkel said. “But we have listed many other non-hormonal and over-the-counter- options that physicians can use as well, and each of these options can be discussed with patients.”
What is HRT?
Hormone Replacement Therapy was developed in the 1960s. Synthetic HRT are different from natural hormones as their composition is changed so that they can be patented. It is designed to replace the female hormones oestrogen and progesterone that the actual aging process takes away. Oestrogen and progesterone are naturally produced by the ovaries until they gradually start to decline as we reach menopause.
Hormone Replacement Therapy is a treatment for women who are in perimenopause or who have reached or passed menopause (you have reached menopause when you have not had a menstrual period for 12 months) following which you are in the postmenopausal phase of your life. It involves taking small doses of one or two female hormones, estrogen and progesterone. According to nhs.uk, HRT remains the most effective solution for the relief of menopausal symptoms and is also effective for the prevention of osteoporosis. In certain age groups it can provide protection against heart disease.
Perimenopause and menopause can be accompanied by many problematic symptoms. For a full list of symptoms see Symptoms of Menopause.
The therapy is available in oral forms, implants, skin patches, creams and gels. The type of therapy you are prescribed very much depends upon your current health status, medical history and the severity of your symptoms.
Low-dose vaginal preparations of oestrogen in the form of gels, tablets or rings can effectively treat vaginal symptoms and some urinary symptoms, while minimising absorption into the body. Furthermore, blood clot risk is lower for oestrogen-only, transdermal and vaginal oestrogen hormone therapy.
The Benefits of HRT
According to nhs.uk, HRT benefits include:-
- Controls menopause symptoms: hot flushes/flashes, vaginal dryness, urinary tract infections, loss of libido
- Prevents heart disease
- Prevents osteoporosis
- Prevents some hard to detect female cancers
The Risks Associated With Hormone Replacement Therapy
According to nhs.uk, there can be drawbacks to HRT as it slightly raises your chance of developing the following conditions:-
- Breast cancer (You can read a summary of the UK’s NICE 2015 guideline in relation to HRT and breast cancer risk here)
- Ovarian cancer
- Deep vein thrombosis and pulmonary embolism (a clot in the lung)
Your healthcare professional may recommend that you do not take Hormone Replacement Therapy if you have:-
- A history of breast or some other cancer
- A mother who took DES (Diethylstilbestrol) during pregnancy. DES was prescribed for women from the 1940s to the 1960s to prevent miscarriage. It was later established that it causes changes to the reproductive system in the daughters of the women who took it.
- Previous blood clot in lungs or leg
- Recent heart attack or poorly controlled angina
- Undiagnosed vaginal bleeding
- Gallbladder disease
- High blood pressure
- Liver disease
- Migraine headaches
When Should You Start To Take Hormone Replacement Therapy?
When you should begin the therapy largely depends on the reasons why you want to take it. If you want to take HRT to control menopause symptoms which can continue sporadically for several years but will eventually end or certainly become less significant; most women start the therapy when their symptoms are severe enough to interfere with their everyday life and then discontinue when they no longer need it. If you decide to take it for its protection against osteoporosis, the greatest level of protection is obtained when it is started soon after menopause. It is reported that HRT should be started within 5 years of menopause in order to have any significant effect on bone density.
Regular medical check-ups are important whether or not you are taking HRT. These should include blood pressure check, a pelvic examination, a clinical breast examination and mammograms according to the national screening programme.
Whether you are taking Hormone Replacement Therapy or not you should pursue a healthy lifestyle for protection against all age related conditions i.e. regular weight bearing exercise; aerobic exercise such as walking, cycling, swimming; maintaining a healthy diet including fresh fruit and vegetables and whole-grain foods; staying sexually active will help to preserve the lining of the vagina; limited intake of alcohol, stress management techniques such as acupuncture, meditation, relaxation therapy, yoga.
Although millions of women take Hormone Replacement Therapy, it may not be the right choice for everyone. You need to gather as much information as possible and take time to consider your own personal benefits and associated risks and discuss these with your healthcare professional. Medical science does not have all of the answers concerning HRT yet as studies are far from complete.
Ultimately, you must decide for yourself.
Reviewed on: 11/05/2016 by Dr Karen Morton
Next Review: 11/05/2016
HRT: What you should know about the benefits and risks. Retrieved on 16 September 2015. Retrieved from http://www.womens-health-concern.org/help-and-advice/factsheets/hrt-know-benefits-risks/
empr.com (Concise Prescription and OTC Drug Information); Obstetrics & Gynecology Journal 2014;123:202-216;
Betty Hardwick Center, bhcmhmr.org “Guidelines for Menopause of Menopausal Symptoms”, Issued 6 Jan 2014
Hormone replacement therapy (HRT) Retrieved from http://www.nhs.uk/conditions/Hormone-replacement-therapy/Pages/Introduction.aspx
Harrison, P. (Oct 2015) HRT Guidelines Favor Individual Approach to Menopause. Retrieved from http://www.medscape.com/viewarticle/852360