HRT FOR MENOPAUSE

MHT stands for Menopause Hormonal Therapy, previously known as Hormone Replacement Therapy or HRT. If you need help with the symptoms of menopause, don’t be afraid to reach out to us. We treat you as a whole person, analysing holistically what measures can be taken to relieve your symptoms and improve your quality of life.

We can consider using MHT, but we will also focus of the benefits diet and lifestyle modifications will have on your symptoms of menopause. We can support weight control and holistically support your well being.

There are a range of non hormonal and hormonal medications we can use to target your symptoms in the safest way possible and to address your treatment goal in a way that is acceptable to you.

No matter which approach we take (and there are many), you will feel in control of your decision making, empowered with knowledge and information about all the risks and benefits of your chosen therapeutic pathway.

Our best advice is there is absolutely no need to suffer impactful symptoms alone or in silence.

Give yourself the advantage of a personalised menopause symptom assessment.

CAN HRT MAKE YOU PUT ON WEIGHT?

A woman’s body changes dramatically after menopause. Some of these changes can be slowed or reversed using MHT. Local vaginal changes including dryness and bladder irritation can be greatly assisted by restoring estrogen levels. Estrogen MHT can also  help skin to look younger and fuller and hair to be less dry and course. Estrogen is the hormone that makes a woman “pear shaped” with a slimmer waist and distribution of fat around her hips. After menopause, a woman’s body naturally becomes more “apple shaped”, filling out at the waist.

This change can be associated with increased cardiovascular risk and it is thought that women’s natural oestrogen rich status premenopause is protective against cardiovascular disease, a reason that premenopausal women suffer fewer heart attacks and strokes compared with men of the same age.

MHT, per se, should not make a woman gain weight. However, menopause occurs at a time in life where our metabolism is naturally slowing down and our ability to exercise may be limited by other physical health conditions. These events for many women naturally lead to a loss in lean body mass. The average weight gain for a woman during the perimenopause to menopause transition is 2.3 kg. However body composition changes are more dramatic than fat gain.

Taking a holistic approach to menopause care, regardless of whether a woman uses MHT or not, we can offer diet and lifestyle focussed assistance and support to help our patients achieve weight loss goals and to attain and maintain a more ideal body weight, shape and BMI (Body Mass Index). There are many health benefits of achieving and maintaining a healthy BMI including reduced risk of age associated diseases such as cancer (including breast cancer), cardiovascular disease and dementia.

By embracing health goals at the life milestone of menopause, we can promote and support women living better for longer. We want you to feel, look and function at your best.

Here’s a checklist you can follow which forms part of our mantra:

  1. Get advice early so that menopausal symptoms and other body changes can be targeted for better satisfaction and achievement of longterm outcomes.

  2. Eat a healthy diet (we can help)

  3. Maintain a healthy body weight (we can help)

  4. Engage in physical activity and weight bearing exercise

  5. Stop smoking

  6. Moderate your alcohol use

  7. Get enough sunshine or supplement vitamin D

  8. Get enough calcium (preferably from dietary sources)

  9. Regulate your sleep patterns and get enough rest (we can help).

Skin changes in menopause:

Women can feel very distressed at the skin changes that occur naturally after estrogen withdrawal at the time of menopause. These include loss of elasticity, dryness, increased skin wrinkling, loss of subcuticular fat causing skin thinning and increased visibility of small blood vessels. Sun over-exposure and smoking aggrevates these factors and should be avoided. Happily there is now much that can be done to help.

Hair changes in menopause:

Changes in hair distribution in menopause are common and can be very distressing to women. Pubic hair reduces and thins while other areas like the face and chin can become more hirsuit.

Loss of scalp hair can occur in the form of thinning or in a receding hairline or male pattern. Hair texture can become coarser and less soft.

WHAT ARE THE RISKS OF TAKING HORMONE REPLACEMENT THERAPY?

When a woman chooses to use MHT, it is important that she is fully informed of all the risks as well as the benefits. We use retrospective studies of large groups of women to advise modern women of MHT risks and there is a lot that we can do as medical practitioners, knowing what the risks are to minimise a) the risks themselves and b) their impacts on women.

We know that amongst women who use MHT including a progestagen there is a small but real increase in the prevalence of breast cancers. This has not been shown in every regimen and more natural progesterone forms (micronized progesterone) are thought to be safer than synthetic alternatives. An increase in breast cancer risk after menopause has not been reported using intra-uterine delivery systems (IUDs).

It is important to be aware that every woman is at risk of breast cancer and 1 in 12 women will develop a breast cancer over our lifetime. From retrospective analysis of the WHI study (Manson JAMA 2013), it is thought that 0.1% more women develop breast cancer using MHT compared with non MHT users (1:1000 more women developed breast cancer in the combined estrogen and progesterone MHT group. The estrogen only MHT study arm in women who had a hysterectomy did not demonstrate an increased risk of breast cancer).

We know that when women use MHT for a long time, risks of cardiovascular events like heart attacks and strokes become more common. Women have fewer cardiovascular events in their 40’s and 50’s compared with men and women using MHT over are still at lower risk of these events than a same-age man. Using the lowest dose of MHT for the shortest time needed via the safest delivery system can mitigate this risk. Even more important is patient selection. We can choose to avoid MHT if we identify a women as being at higher risk of cardiovascular disease or stroke on the basis of her medical or family history.

SEXUAL PROBLEMS AT MENOPAUSE

Many women experiencing menopause have decreased sexual desire and sexual satisfaction. Women also suffer body confidence issues. Sleep disturbance and profound fatigue due to hot flushes and unrelenting night sweats does nothing to aid a woman’s libido, which can also reduce due to low estrogen levels.

Urogenital changes can lead to vaginal dryness which can cause skin abrasion and sexual pain. There is much we can do to help and the earlier we address these issues, especially relating vaginal conditioning, the more we can do to ensure a longer lasing satisfying sex life for women and couples.