Dr Michelle Griffin, medical doctor and a qualified gynaecologist, shares the best way to understand and manage your menopause journey, and how to explore HRT risks and benefits.
What is HRT?
The NHS defines HRT as a treatment to relieve menopause symptoms. It replaces hormones that are at a lower level as you approach the menopause. Read our guide to body identical and bioidentical hormones.
If you think logically, the root cause of menopause relates to the reduction of oestrogen and progesterone in a woman’s body. Therefore, replacing these has got to work – right? Sounds simple enough doesn’t it?
“However, it’s far from simple – it’s just not a black and white situation,” says Dr Griffin. “Yes, it will definitely improve menopausal symptoms for a woman and it has been shown to be the most effective intervention to date. But it is important to note that each woman’s experience will be different and that HRT will achieve a different outcome for each person.”
“However, the good news is that the more women learn about menopause, the better they can manage their menopause journey and make informed decisions about the treatment they have (or don’t have), resulting in a more positive experience.”
Understanding your menopause journey
The average menopause journey is about 10 years and everybody’s experience will be different”
“So let’s start with the basics. It’s important for women to understand that menopause is a journey that may last up to 10 years or even more, and that everybody’s symptoms will be slightly different, and your symptoms will change throughout the journey,” says Dr Griffin.
“At around 40 to 45 years old, you may start to experience some symptoms that seem unrelated and random. These may include not only hot flushes and irregular periods, but anxiety, depression, sleeplessness, fatigue, lack of concentration, mood disturbances – in fact a whole host of seemingly vague symptoms.
“The root causes of these symptoms are not always clear. They could be related to reduced levels of hormones but could also be due to another medical reason unrelated to menopause – the question is how to manage them. Find out more about the stages of menopause. “
Read more about symptoms in our symptoms library.
How do I know if I need HRT?
“Every woman experiences a different menopause and a woman does not have to go on HRT. In fact many women go through menopause without it. The key point is to be led by your symptoms and how they are affecting you,” says Dr Griffin.
“If you are managing well, continue with your plan and take it day-by-day. Just be sure to seek help if that changes. Most symptoms will reduce and settle with age as the hormones settle to their new normal level. However, vaginal dryness and irritation can be an increasing problem as the tissue responds to the increasing lack of oestrogen. This can be managed successfully with topical oestrogen.”
How long does HRT take to work?
Typically, your body will take between 6 weeks and 3 months to fully settle down once you start HRT. It may take a few weeks to feel any benefit from HRT and you may experience some side effects at first.
At 3 months, you should check back in with your GP to review symptoms, any side effects, concerns and changes to their medical history. At this point, you can discuss with your GP whether you need to make any changes – this can include increasing dose, but also potentially changing the type of oestrogen (such as gel or spray).
HRT risks and benefits
When you have visited your GP, empowered with knowledge and understanding of menopause and the HRT options that are out there – what next? In the early 2000s, HRT was often demonised in the media and was subsequently viewed quite negatively by most women – however, that has changed within the past few years.
“It is important to understand that, as with any other medicine, HRT presents certain benefits and risks – and these will vary from person to person,” says Dr Michelle.
The biggest benefits of HRT is effective treatment of challenging menopausal symptoms:
Long-term health impact
- Heart disease: There is evidence that women who start oestrogen only or combined HRT before they reach 60 years of age have a reduced risk of coronary heart disease and death from cardiovascular disease – which is the second highest cause of death in women in the UK
- Osteoporosis: There is also evidence that HRT protects women’s bone mineral density and reduces the risk of osteoporosis
- Cancer: Women taking combined HRT may also have a reduced risk of bowel cancer
“Each woman, together with her GP, should evaluate her individual risk (and some of these are very slight), then weigh those against the benefits of taking HRT. Also, there are many different preparations and doses of HRT which can be tailored to your needs and risk profile.”
“It is crucial to have the conversation with your doctor, so that you can make a fully informed decision about HRT – taking into account the risks and benefits that are personal to you.”
- Blood clots
HRT and breast cancer
Current evidence shows that oestrogen-only HRT has little to no change in your risk of breast cancer, and vaginal oestrogen is not associated with increased risk in breast cancer. Combined HRT (oestrogen and progesterone) may be associated with an increased risk but this is low especially when compared with the risk of drinking alcohol and being overweight
“Once the decision has been made that HRT is a suitable treatment for you, your doctor will help you decide what to take and whether that is a patch, gel, spray, implant, cream or pill as well as when the treatment will begin,” says Dr Michelle.
“The ultimate goal is to achieve the right dose for managing symptoms while keeping the risk as low as possible, and to adjust it until you reach that point,” says Dr Michelle.
How long do HRT side effects last?
“It is crucial to have regular reviews with your doctor – at least within the first three months when you start and then once a year, to check whether the treatment is working or the dose needs adjusting to combat breakthrough symptoms, as well as monitor for any side effects you may be experiencing,”says Dr Michelle.
As with many treatments, there can be adverse side effects which usually go away within a few months. You might need to go back to your doctor a few times to change the type, dose or preparation.
How does HRT make you feel?
Oestrogen HRT can cause:
- Fluid retention
- Tender breasts/enlargement
- Nipple sensitivity
- Nausea, headaches
- Leg cramps
Progesterone HRT can cause:
- Fluid retention
- Breast tenderness
- Mood swings
- Lower abdominal pain
Read more about red flag symptoms during menopause.
Talking to your GP about HRT risks
It’s important to empower yourself with knowledge about HRT risks and benefits, so make sure you use a good source of information, such as on Stella or visit the NICE (National Institute for Health and Care Excellence) Menopause Guidance website. Don’t be deterred by the masses of information on the site – NICE condenses complex issues into easily understood, bite-sized paragraphs.
Women should be aware of the long-term risks and benefits of HRT”
“When you’re armed with quality information, visit your doctor. Often, women can feel they have not been listened to by their GPs or their GP is not aware of the latest evidence. That is why your research is important because you can then talk to your GP knowledgeably and understand your options. You can also get the reassurance that you are on the right track or if Google has steered you completely in the wrong direction.”
How long can you stay on HRT for?
There is no set duration for taking HRT and no maximum limit. However, the primary rule is regular reviews”
“Most doctors will normally discuss continuing with you when you reach 60, when symptoms are likely to have settled and it is a decision about long-term risk benefit,” says Dr Michelle.
“You will then need to work out a long-term plan – not just looking at being on HRT for the next 50 years – and this is where Stella is an invaluable tool. If you use it as an integral element of your overall treatment during menopause, including HRT, it can help you to formulate a plan for your life before, during and postmenopause.
“Stella offers women help to manage their menopause journey and sets them up to enter their 60s and 70s in a much healthier position than previous generations before them.”
Final word on HRT risks and benefits
“Should women take HRT? Every woman should look at it as an option and not dismiss it at source. Empower yourself through knowledge, talk to your doctor, share experiences with your friends and make an informed decision that is the right one for you.”
Stella will have a significant and positive effect by helping women manage their menopause better”
“Through Stella, women are fully aware and understand all their options, and realise that they do not have to endure what the women of previous generations were forced to through lack of knowledge and clinical intervention.”
Find out more about menopause symptoms on our blog.