With so much information available to women, there is scope for confusion around the menopause and its treatment. It is natural for you to have questions and to want answers and I would like to help you cut through any confusion to give you information about the menopause and the latest thinking surrounding HRT as a suitable treatment, which your NHS GP may be able to prescribe for you. There is lots of language used to describe the different stages of the menopause, but what does it all mean and who can it impact?
The average age of menopause is 51 and women can experience symptoms for a number of years after that. There are women who will not become menopausal until their mid to late 50s, and equally there are women who will experience the menopause earlier. If you experience symptoms earlier between 40 and 45, it is referred to as the early menopause. Many women will experience symptoms sometime before they stop having regular periods we call this the perimenopause. There are also women who enter the menopause earlier than they otherwise would have done due to treatments they have received for other conditions such as Endometriosis or cancers.
If you reach the menopause before 40, it is called premature menopause or premature ovarian insufficiency.
Information around treatment for the menopause can also be confusing, particularly around hormone replacement therapy, often referred to as HRT as it is often very general and usually does not always consider the individual risk of women. HRT is not new, it has been used for treating menopause for around 50 years, starting in the 1970s and in that time there have been many changes. There are a range of products to choose from and doctors are now very skilled at working with women to work out which hormones they may benefit from
and how these hormones would best be given is that in a patch, a gel, an oral medication or through vaginal creams or pessaries, it means that the doses, the formulations and the method of delivery of hormones are now not comparable to the way hormones were used 20 years ago. HRT has been seen as controversial in the past, mainly due to studies published in the early 2000s which cast a significant shadow on HRT use worldwide. This resulted in millions of women being advised to stop their HRT treatment and many more millions of women being denied HRT treatment for the decade or so that followed. The types of hormones used
now, the modes of delivery and the population of women we now treat are all different to those observed in the study 20 years ago. Therefore, it is important that we re-educate a generation of women and their doctors on whom to prescribe hormones to whilst ensuring this is done as safely as possible.
The risk of breast cancer from use of HRT is not as significant as many may believe. Some studies show that taking combined HRT, that is HRT combining both oestrogen and a progesterone may be associated with a very small increased risk of breast cancer. However, this information has been generally misinterpreted, which has made people fear that the risk is far greater than it actually is, leading women to feel confused and anxious about the perceived risk of breast cancer.
Let us put it into context for those women with an increased risk of breast cancer, i.e. older women, those taking HRT for longer periods of time or those taking older types of combined HRT, the risk of breast cancer is similar to the level of risk associated with any woman not taking HRT who is overweight or drinks around two glasses of wine a day. So context in this example is really important this is how we better understand the risks.
For many women there is no increased risk of breast cancer, such as if they are under 50, if they only need oestrogen, or if they are taking a more modern form of progesterone known as micronised progesterone.
Everyone is susceptible to breast cancer. Our personal risk is made up of two factors our inherited risk and modifiable risks. Our inherited risks are made up of factors such as gender at birth, age, family history, we know that women are higher risk than men, older women are higher risk than younger women and some types of family history of cancer can also indicate a higher risk. We cannot change our inherited risk, however we can change our modifiable risks,
we can lower our overall risk of breast cancer. We have clear evidence that certain lifestyle choices can affect our risk of breast cancer therefore, if we change our lifestyle, we are able to reduce our personal risk. Drinking, alcohol, smoking and being obese are significant risk factors for breast cancer therefore, we can confidently say that by reducing your body fat, limiting your alcohol intake and stopping smoking, you can reduce your personal risk for breast cancer. Low oestrogen levels caused by the menopause can lead to a number of physical and emotional symptoms, including hot flushes, low libido, night sweats, brain fog, muscle and joint pains and mood swings.
The benefit of HRT is that it can help to ease many of these symptoms and improve your quality of life. Your doctor may suggest you consider HRT if your symptoms of the menopause interfere with your daily life. As well as dramatically improving menopause symptoms HRT also reduces your risk of osteoporosis and may help other health problems associated with the menopause, such as cardiovascular disease and stroke.
For the vast majority of women, there is clear evidence that HRT is likely to be more beneficial than potentially harmful. However, there are a handful of conditions that may affect your ability to take hormones. So it is important that you have a full consultation with your doctor before you take any medication.
A whole generation of GPs trained or worked as GPs during the 2000s when HRT went out of vogue due to widespread negative press, as a result, some GPs became de-skilled in recognising menopause and prescribing HRT. Since then, prominent medics and scientists have voiced concerns about the statistics and conclusions drawn from those studies publicised in the 2000s. Whilst less HRT was being prescribed, a number of other medications, such as antidepressants and supplements were explored to see if they were effective alternatives.
Although some antidepressants have been found to improve hot flushes for some women none of the alternatives have been found to be as effective as hormone replacement. Menopause specialists around the world are now found to be empowering women by providing improved information which allows women to understand their personal risks and benefits when considering whether HRT is right for them. It is essential that every woman is looked at as an individual, assessing her symptoms and her risks with a professional to share the decision about the best treatment for them.
It is important that women can make their own informed decisions as to how to approach their treatment and that they are offered HRT when appropriate. If you are experiencing symptoms of the menopause, I would encourage you to read widely on the topic, discuss with friends or family, and understand your own risks and your own thoughts about which treatment or approach appeals to you. I then recommend that you have a chat with your doctor and together discuss the potential risks and benefits of hormone treatment for you whilst considering what lifestyle changes you could engage in to either manage your symptoms or minimise any risks to your long term health.
HRT can be obtained through your NHS GP, but whether you are a customer or not, there is lots of support which Bupa can offer you, including expert advice and support in our women's health hub and the Bupa Health Clinics Menopause Plan and for Bupa customers, we provide support on any mental health symptoms related to the menopause. You can also speak to a menopause trained nurse throughout Bupa any time Healthline or a GP through Bupa Digital GP. As a perimenopausal or menopausal women today please feel reassured that so much more is known about the role of hormones in our general health
that you can feel very optimistic about menopause care now and in the future.