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Hormone Replacement Therapy (HRT)

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Hormone Replacement Therapy (HRT) for women is a topic of confusion for not just the public and patients- but also for doctors themselves because of conflicting conclusions from research studies. While the details of the controversies are beyond the scope of this note, let us touch on the major issues that surround the prescribing of HRT.

HRT involves taking hormones (either natural or identical synthetic molecules) to alleviate the difficult symptoms experienced by women at any age between 40-60 years old as their own oestrogen hormone levels drop and their periods gradually halt. Symptoms such as flushing, night sweats, vaginal dryness, loss of libido, mood changes and disturbed sleep are typical. They can last for 5-10 years but are at their worst early on. Flushing and night sweats are the most commonly reported symptoms affecting 80% of women during this time of change, which leads women to seek medical advice.

Before considering HRT, a doctor should check there are no related concerns by excluding active vaginal bleeding, previous clots, previous heart disease and cancers. Doctors may also do tests to confirm there is no immediate risk before prescribing.

HRT prescriptions commonly take the form of oral tablets of the oestrogen hormone. For women with a womb, it is recommended to have progesterone tablets for part of the cycle too. The tablets can be taken either for a certain period every month allowing for a bleed or, if that doesn’t work, as a regular continued daily dose.

However, HRT can also be delivered through patches, creams, gels and coils. In general, the non-oral forms are associated with lower risks and side effects as compared to the tablets.

The reduction in oestrogen also leads to a subsequent increased long-term risk of osteoporosis (thin bones), heart disease and stroke. So part of the reason to take HRT is to combat these long-term risks. However, as the saying goes, ‘there is no such thing as a free lunch’ and HRT has also been associated with increased long-term risks of blood clots, breast cancer, endometrial cancer and ovarian cancer alongside the side effects of the hormones (oestrogen and progesterone) themselves and the commonly resulting irregular vaginal bleeding in the first 3-6 months of taking HRT.

The scientific evidence for HRT being associated with these long-terms risks is evolving and unfortunately, this has often meant a change in recommendation from the medical community, creating confusion for patients. Even in February this year, a new report in the Lancet found, against previously accepted guidance, that there is a slight increase in the risk of ovarian cancer. Therefore, if you are considering HRT or are currently on it, it is important to research the long-term benefits and risks further before making a decision.

While it may seem that HRT is so confusing that it is best avoided, it is worth remembering that it can be very effective against the very real and now symptoms of menopause. Many of the long-term risks mentioned above can be analysed further to more specifically apply it to the particular patient. So it is vital that you discuss your individual case with your physician to decide the best course of action for you.

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