menopause

For years, women going through menopause had few good options for relief from symptoms like hot flashes, night sweats, and vaginal dryness. Hormone replacement therapy (HRT) existed, but it was surrounded by misinformation, safety concerns, and product shortages that limited access. Many women avoided HRT or couldn’t get it easily. However, that’s finally starting to change. Recent educational efforts, updated medical guidelines, policy reforms, and advocacy are transforming HRT’s reputation and availability. What was once an underutilized and controversial treatment is becoming a mainstream way for women to manage their menopausal symptoms safely and effectively.


What is Menopause?

Menopause is a natural biological process that marks the end of a woman’s reproductive years. It occurs when the ovaries stop producing estrogen and progesterone, the hormones that regulate the menstrual cycle.

Technically, menopause is defined as occurring 12 months after a woman’s last menstrual period. The transition leading up to this point, marked by irregular periods and fluctuating hormone levels, is called perimenopause.

The average age for natural menopause is 51 in most developed countries, though it commonly occurs anytime between the ages of 45 and 55. However, menopause before 40 is considered premature.


What is HRT and Who Needs It?

Hormone replacement therapy (HRT) is a treatment that replaces the hormones that a woman’s body no longer produces after menopause. It is primarily used to relieve menopausal symptoms like hot flashes, night sweats, vaginal dryness, and reduced sex drive. HRT may be recommended for women experiencing moderate to severe menopause symptoms that interfere with daily life.


Why is HRT Important?

While hot flashes and night sweats are the hallmark complaints driving many women to seek hormone replacement therapy (HRT), the rewards of restoring hormonal balance extend far beyond providing respite from those bothersome symptoms. HRT plays a vital role in fortifying overall health and preventing long-term consequences of estrogen deficiency.

  • Preserving Bone Strength
    The precipitous drop in estrogen levels after menopause puts women at increased risk for osteoporosis and debilitating fractures. HRT has been shown to effectively maintain bone mineral density and reduce the likelihood of developing this potentially crippling condition.
  • Boosting Brain Power
    Cognitive decline and memory issues can be particularly concerning menopausal changes. Encouragingly, research like the Neurobiology of Aging study demonstrates HRT’s potential to improve verbal memory, focused attention, and other cognitive functions in perimenopausal and postmenopausal women.
  • Revitalizing Vaginal Health
    Up to half of postmenopausal women endure the painful condition of vaginal atrophy – thinning, dryness, and inflammation that can make intercourse excruciating. HRT provides relief by reviving vaginal tissues and restoring proper lubrication.
  • Cardioprotective Effects
    Long-standing fears around HRT and cardiovascular risks have been upended by robust clinical trials like the landmark 2020 WHI study. This research revealed that initiating HRT before age 60 may actually decrease the risk of heart attack and other adverse cardiovascular events.

Who Cannot Take HRT?

HRT is contraindicated for women with hormone-dependent cancers, liver disease, undiagnosed vaginal bleeding, blood clots, or stroke history. It is advised to discuss your full medical history with the doctor for appropriate risk assessment.


When Should You Start HRT?

The optimal window is typically within 5 years of your last period, though some women further from menopause may still benefit. Starting earlier tends to maximize benefits while minimizing risks.


What Are the Risks and Side Effects?

Potential HRT risks include blood clots, stroke, heart disease, and breast cancer – especially with prolonged use. Common side effects are bloating, breast tenderness, headaches, and irregular vaginal bleeding.


What Screening Is Recommended Before and During HRT?

Before starting HRT, your doctor may order mammograms, cervical cancer screening, bone density scans, and blood tests. Regular monitoring continues based on your age and risk factors.


Why Are There Different Types of HRT?

There are multiple HRT formulations to allow treatment customization based on individual factors:

  • Uterus Status:
    Women without a uterus can use estrogen-only HRT, while those with a uterus need estrogen plus progestin to prevent endometrial cancer risk.
  • Hormone Types:
    Specific estrogen and progestin molecular forms may be better tolerated or preferred.
  • Administration Route:
    Oral pills, patches, gels, vaginal products – each has pros and cons for absorption, side effects and convenience.
  • Dose Levels:
    Dosing is tailored to symptom severity, age, hormone levels and existing conditions.
  • Personal Preference:
    With equivalent options, a woman’s preference for mode of delivery can be considered.

When Should HRT Be Stopped or Reevaluated?

HRT should be reevaluated periodically, especially after the first 3-5 years of use. It may be stopped if menopausal symptoms subside, or health risks increase. Some women take it indefinitely under close supervision. It’s recommended you speak to your GP about how long you should be on treatment for, and you can stop HRT either gradually or suddenly. Stopping HRT suddenly can exacerbate side effects. By decreasing your dose slowly over time, menopause symptoms are less likely to come back.


If you’d like to schedule an appointment to discuss if whether HRT could be an appropriate treatment option based on your individual needs and risk factors, please contact The Brook Surgery. You can either email us at reception@thebrooksurgery.com or call our surgery at 020 7435 0211. Our friendly staff will be happy to assist you.

Remember, HRT is not a one-size-fits-all solution, but a therapy that should be personalized for your specific situation.