Let’s talk about HRT and the Menopause

Let’s start with some rough numbers. There are roughly 65 million people in the UK, roughly half of them are women and roughly half of them are at or above the age at which women start to experience the effects of the menopause. That is roughly 15 million women (a quarter of the population!).

The menopause is a relatively new mass phenomenon because frankly until recent decades most women did not live beyond their sixties! But Hormone replacement therapy (HRT) first appeared back in the 1930’s and used by women to relieve the symptoms caused by the menopause, for example, foggy brain, hot flushes, night sweats, mood swings etc. Such symptoms can be very unpleasant but taking HRT offers many women relief through replacing the hormones they are lacking when approaching the menopause.

The key word in HRT is REPLACEMENT, this is not introducing some form of new therapeutic into women’s bodies but replacing something that the woman is no longer able to produce at sufficiently high levels. It was both surprising and a great act of poor journalism that saw a number of damming articles being produced in the 1990’s with headlines suggesting that HRT was harmful, causing a range of conditions from breast cancer to heart disease. These articles resulted in an almost 50% reduction in the prescription and willingness to take HRT. Not only were the promulgated statistics misinterpreted resulting in the removal of the benefits of HRT to millions of women, it’s likely that many women actually died unnecessarily from not benefiting from positive side effects of taking HRT.

HRT herbal alternatives

Herbal alternatives, labelled as menopause support, are thought to offer similar if not the same benefits to HRT. However, to date these supplements have failed to prove clinically that they have any benefit, are lacking research and knowledge around the ingredients used and have yet to provide evidence of their impact. Fundamentally HRT replaces human hormones with synthetically produced hormones that mirror those found in the human body. It is unlikely therefore that replacing human hormones with “natural” plant hormones would be a solution. Acceptance of these products is fuelled by little more than advertising and the public’s desire to believe them. Despite some women craving a ‘natural’ alternative to HRT, products are awaiting testing due to (1) failure to meet study standards, (2) unknown doses of active ingredients and (3) unclear levels of effectiveness.

The Damage of the Menopause

Current research into the long-term hormone deficiency, when HRT was not taken, is diametrically opposed to the articles in the 1990’s. You may ask why these articles matter, as is the case with anti-vaxxers, a small number of powerful articles picked up by the media have been able to enter the public’s psyche. Even today when surveyed, many women of menopause age refer to the “risks of breast cancer and heart disease” associated with HRT. In fact not taking HRT has shown to lead to increased risk of heart disease, dementia, osteoporosis, and diabetes. Dementia has been the biggest killer of women in the UK for the last 10 years. The lack of oestrogen has been associated with the shrinking of a particular part of the brain associated with Alzheimer’s, one of the reasons why women are more susceptible to the disease than men. Cardiovascular disease is another common cause of death, women are put at a particularly heightened risk after menopause, at which point heart attacks are 5 times more likely to occur. Those who have taken HRT however appear to achieve a 50% reduction in their chances of heart disease. Offering women the opportunity to reduce this risk with HRT is something women across the world are still fighting for.

In a podcast with Dr Louise Newson, My Menopause Doctor, Davina McCall, English TV presenter and creator of the Sex, Myths and Menopause documentary, claimed “we should all be taking HRT”.

A common symptom for women going through the menopause is a lack of and disturbed sleep. People who don’t sleep are known to have an increased risk of heart disease, obesity, depression, and even early death, all of which are also linked with hormonal changes. Through alleviating symptoms, women taking HRT have been able to alleviate menopause insomnia, hot flashes during the night, sleep disordered breathing and other sleep disorders associated with the menopause.

The reproductive hormones, oestrogen and progesterone, are associated with both poor mental health and menopausal symptoms. Mental health disorders vastly impact women as they approach the menopause and with a high rate of suicide presenting itself among women aged 45-54 years, there is reason to believe that this may be linked with the biological changes women experience during this age. Perimenopausal depression is widely under-recognised and menopause symptoms such as low self-esteem, reduced motivation, anxiety, irritability, panic attacks, poor concentration, and low energy, are often mistaken for and wrongly treated as depression. More extensive research is needed to enhance and speed up diagnosis and treatment.

Research for long-term HRT usage

The UK’s MHRA (Medicines Healthcare products and Regulatory Authority) has not yet updated HRT labelling and leaflet requirements with recent evidence about HRT. Without these updates, unnecessary warnings will be issued. The most ridiculous fact is that there is a lack of funding for research, limiting our HRT knowledge. Given the size of the issue and the clear reduction in productivity from women suffering the effects of the menopause, the cost to the economy is enormous. Given the ageing population and a need for the current generation to work longer this makes no sense to the UK’s economy. Doctors are poorly trained in this area of medicine and this lack of research adds to the uncertainty surrounding HRT’s prescription. Additional research is urgently needed to provide clarity around the benefits and risks, in turn equipping doctors and patients with the information needed to make the most appropriate decision for them.

Despite the benefits, shame remains around taking HRT with people believing it to ‘go against nature’s path’ and have a direct link to increasing the chances of a cancer diagnosis. This demonisation of HRT and the menopause has caused women to either suffer in silence, or experience great shame in taking HRT to ease symptoms. Davina McCall talked about feeling ‘great shame’ during a Facebook live event last year. Davina felt as though she was chasing her youth and that taking HRT would make her appear weak when compared to her friends who were battling on through it.

Only when people are educated as to the effects of the menopause and the benefits of HRT, for the vast majority of women, will we reap the rewards to our economy and society as a whole.

For more information and to join the community raising awareness for menopause and HRT, please visit The Menopause Charity.

#ownyourmenopause