The Menopause and Hormone Replacement Therapy

The average age of the menopause in the UK is 51. This is lower in smokers, and women from the Indian subcontinent. A menopause before the age of 40 is defined as a ‘premature menopause’, and also ‘premature ovarian insufficiency’. Women who have a premature menopause are at greater risk of osteoporosis.

The characteristic symptoms of the menopause include: hot flushes, night sweats, vaginal atrophy (vaginal dryness, psychological symptoms including low mood, anxiety and forgetfulness, joint and muscle pain, sleep disorders and a loss of libido.

The menopause develops when your ovaries stop producing the hormone oestrogen, and the symptoms occur as a direct result of the loss of oestrogen. The loss of oestrogen may not only increase your risk of osteoporosis, but will also lead to thinning of the vaginal mucosa, and a loss of the necessary acidic vaginal PH. This will lead to vaginal atrophy, and can cause an irritable bladder, and recurrent urinary infections.

Every woman will have different menopausal symptoms, but in the UK many women now opt for Hormone Replacement Therapy to reduce the severity of the symptoms.

The medical literature supports the use of HRT from the start of the menopause, and the benefits may be reduced if starting treatment a year after the last period.

There is a key relationship between postnatal depression, and severe peri-menopausal symptoms and the menopause. Earlier intervention and HRT support is effective at reducing depression.

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What is the Menopause?

The definition of the Menopause is one year after stopping periods. It is preceded by the peri-menopause, and the classic symptoms can be severe for at least 5 years before the menopause starts.

What are the benefits of Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) has been used for over 50 years to relieve menopause symptoms. Some women will choose to use a symptom diary to monitor a record of their symptoms. Menopause symptoms are directly caused by a reduction in the amount of the oestradiol.

The main hormone in HRT is oestrogen. It will reverse the deficiency of oestrogen caused by the menopause. Some HRT products will include a progesterone or progestogen (a synthetic progesterone). Progesterone is normally produced by the ovary, and protects the endometrium, the lining of the uterus, and protects the endometrium from overstimulation (hyperplasia).

If a woman with a uterus uses HRT, then progesterone/ progestogen will help protect the lining against over-stimulation by oestrogen. Currently, we prescribe a combined HRT with oestrogen and either a cyclical progesterone/ progestogen or continuous progesterone/ progestogen (no bleed HRT).

Why do women take HRT? (Menopausal symptom relief)

The classic menopausal symptoms include night sweats, hot flushes, mood swings, memory problems, aches and pains, reduced libido, and vaginal dryness. In my experience, each woman will experience different issues with varying levels of severity, and as a clinician I will need to advise the right treatment programme. We have known for many years that HRT relieves menopausal symptoms.

If HRT does not work, and is medically contra-indicated, or is not an individual’s preference, there are other treatments which can be considered.

How long does HRT take to work?

HRT will normally take a few weeks until the initial benefits are felt. In my experience, the best effectiveness will be by 6-12 weeks, as hormone levels settle and symptoms continue to improve. I like to review patients after 3 months, and then every 6-12 months.

The different types of HRT products?

Menopause FAQ's

Can any woman take HRT?

HRT is contraindicated if you have suffered from breast cancer, or if you have a tendency to thrombosis. If there is history of breast cancer, I now offer genetic screening.

What is the most effective HRT?

A cutaneous oestrogen with oral progesterone, or a Mirena coil.

How long can I take HRT for?

I prescribe standard HRT to women until they reach 70.

Can I take HRT if I have had a venous thrombosis?

HRT is contraindicated if you have a history of venous thrombosis or pulmonary embolus.

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