Hormone replacement therapy (HRT) has been a hot topic for a while, especially when it comes to easing menopause symptoms. It can really help some women feel better, but it also comes with some risks. Over the years, our understanding of HRT has changed a lot.
Hormone replacement therapy: What is HRT?
You may or may not have been around long enough to remember this, but about a decade ago, hormone replacement therapy, or HRT, was considered a Very Bad Thing indeed. In short, stories of HRT-related strokes, blood clots, and, yes, cancer were rife. And it does seem that particular aspects of replacement hormones like dose and regimen could increase instances of the above. As a result, many doctors reportedly became reluctant to prescribe the treatment to any woman, not at risk of osteoporosis. Now, if you’re wondering what menopause has to do with your bones, strap in. It’s about to get a tiny bit scary…
While menopause is mainly about the end of your natural fertility, it also heralds a bunch of other changes that you’d think would have nothing to do with your ovaries. But they very much do. And the loss of bone density is just one of them. Yup, that tailing-off of estrogen and progesterone can also cause brain issues and thin skin as well as brittle bones. Crazy, right?
Of course, menopause also brings with it night sweats, brain fog, hot flashes, sleep disturbance, irregular periods, mood swings… It’s an exhaustive list that, frankly, sounds like a nightmare. Thankfully, though, it is a finite nightmare. But it is a nightmare that’s individual to each woman. As such, and because we’re talking about women’s medicine here, there are just a few general pointers to look out for.
The real menopause
Generally speaking, what we all know as the menopause actually occurs in two distinct stages. The first – Perimenopause – can happen anywhere from age 40 onward, but usually occurs around your mid-40s to mid-50s. It’s characterized by all of the above-mentioned symptoms like hot flashes, thin skin and brain fog, Although it’s the erratic periods that really signify the beginning of the end, in a menstrual sense.
The actual menopause, though, is a moment in time 12 months after your last period and is part of perimenopause. All told, the first stage alone can take up to 14 years. Four. Teen. Years. And those symptoms can make life absolutely miserable for older women – anyone who’s ever had a hormonal issue will have some idea of just how bad it can be. And we’ve all got it to look forward to.
The good news is, though, that it does end. And that’s when you enter the second stage: Postmenopause. Which, essentially, is the rest of your life, sans reproductive function. And, in turn, fewer troublesome hormones. But while that might sound like a dream come true for some, for a lot of women, getting to that post-menopausal stage can be a tricky and emotional journey.
Is HRT the answer to your prayers?
Step forward HRT. Now, we’re in no way saying that replacement hormones can in any way help with the emotional rollercoaster that the end of your fertility can kick off. But what it can do is help curb those symptoms, like thin skin and brittle bones, and allow you to actually focus on how you feel. So how does it do that?
HRT performs a similar function to that of hormonal birth control. It also keeps your estrogen and progesterone at higher levels than they naturally are when periods have stopped, but not as high as during reproductive years. And it has the added bonus of keeping brittle bones and thin skin at bay. In addition, like hormonal birth control, HRT comes in many forms, including pills, patches, sprays and even gels. So there’s bound to be a delivery system that works for you. We should caution, though, that HRT is not contraception.
HRT: Are the risks real?
So what was all the fuss about ten years ago? One of the reasons is the change in guidelines. Previous studies included mainly obese women in their 60s, which is not a group of women to whom HRT is recommended nowadays. Most commonly it is recommended to women in their mid 40s to mid 50s to ease their symptoms. In addition, the approach to regimen and doses has changed as well.
However, HRT may come with its own specific set of side effects. Like anything that messes with your hormones, there’s a period of adjustment. And it may look and feel a lot like the actual menopause. From breast pain to swollen body parts, mood changes and acne, all can come hand in hand with HRT. The good news is that they should subside in about three months.
If you’re still having symptoms after 12 weeks, though, it’s definitely time to talk to get some medical advice. And don’t panic. It could be that the delivery system or dose doesn’t agree with you, which is easily fixed. And regular exercise and cutting down on sugar can have amazing effects on the nightmare, HRT or no. As long as you’re having regular check-ups and started HRT under the age of 60, you can take it for at least a decade with little or no increased risk. If none of the things works, though, get a full check-up and make sure it’s hormones and not an underlying medical condition causing the issues.
If replacement hormones are not for you
After all this, though, you may well decide that replacement hormones simply aren’t for you. Thankfully, that doesn’t mean you’re on your own. The non-hormonal treatments available, though, aren’t quite as good, and they don’t appear as safe. Medications like clonidine can help with night sweats and hot flashes but not with thin skin or brain fog. It can also cause hallucinations and blood pressure problems. There’s also evidence that it interferes with certain antidepressants and may increase side effects when taking for example heart medication as well as some other types of medications.
Additionally, there is a drug called fezolinetant that acts on the brain center responsible for regulating body temperature, helping to alleviate hot flashes and night sweats.
And, believe it or not, there is also a completely natural, drug-free alternative for menopause symptoms. It’s NHS Inform and was developed specifically for the nightmare symptoms it produces and has shown crazy results. A 2014 study by King’s College London, which admittedly only involved 140 women, found symptoms had receded within six weeks of starting the therapy. Focusing on lowering stress and anxiety, the cognitive behavioral therapy (CBT) techniques made dealing with hot flashes and night sweats easier, according to the report.
In the end, though, as with all things involving your health and wellbeing, find out what works best for you. Don’t let the change of life ruin your life. Because, why not? We all deserve a good menopause.