This is a question I get asked all the time, which unfortunately does not have a simple answer. Like all medication there are pros and cons, so only by understanding these can we judge better for ourselves.

Menopause

To discuss hormone replacement therapy (HRT) we cannot even start without talking about the menopause, because it is the main reason for taking HRT in the first place. Menopause is a change in hormone levels and HRT is the replacement of those hormones for try to prevent the symptoms of menopause. However, when we replace the hormones it is not a like for like replacement as the natural hormone levels are far more complex.

Women can spend as much as a third of their life progressing through menopause (peri-menopausal, menopausal and post-menopausal), which can come with a raft of symptoms including depression, disturbed sleep, poor memory, incontinence, osteoporosis and coronary heart disease. All of these would make anyone run for the HRT pills, however, how much do they actually prevent these health concerns, and at what cost.

Heart Disease

Oestrogen protects our blood vessels so women are generally less likely to have heart disease than men, but this protection fades with menopause as levels of oestrogen decline. You would think, therefore, that taking oestrogen as part of HRT would have a beneficial effect, but this is only if HRT is started early. If HRT is started more than 10 years after menopause (or after 60 years old), it actually increases the risk of heart disease.

Metabolic Syndrome

Oestrogen also has an amazing effect on women’s metabolism providing a shield against diabetes, high blood pressure and obesity (metabolic syndrome). A lack of oestrogen after menopause can cause the development of these conditions. Unfortunately taking an oestrogen replacement, instead of restoring the imbalance, actually worsens some of these metabolic conditions.

Osteoporosis

One of the major reasons for taking HRT is to prevent osteoporosis, one of the most common bone problems in women, resulting in lower bone density leading to more fragile bones that fracture easily. Oestrogen does have a preventative effect on this loss of bone, and women on HRT have a significant reduction in fractures. However, HRT is not routinely recommended for prevention of osteoporosis because there are other more effective treatments available.

Hot Flushes / Night Sweats

The good news is that hot flushes and night sweats are significantly reduced by taking HRT. Since these symptoms are the ones that affect a women’s send of well-being and quality of life the most this is great news, however must be considered along with the other adverse effects.

HRT Adverse Effects

Like all medications there are some unwanted effects with HRT. Unfortunately taking HRT does increase the risk of developing a blood clot or having a stroke by 2-fold. However, there are some options here because taking progesterone only HRT has no associated increased risk. Also those on HRT have an increased risk of developing breast cancer, even in those women who only take HRT for a short time (less than 5 years). And this increased risk persists even 10 years after discontinuing HRT.

Contraindications to HRT

There are many relative contraindications to HRT but all of these are not absolute but must be taken in the bigger picture.

- History of breast cancer

- History of endometrial cancer

- History of Blood clots

- Liver disease

- Gall bladder disease

- Undiagnosed vaginal bleeding

- Hypertriglyceridemia

- Porphyria

Bioidentical hormones

Most HRT medication is semi-synthetic or synthetic (mainly produced from equine hormones). But lately there has been a much interest around the production of bio-identical hormones. These are derived from plant extract and chemically modifies to replicate the molecular structure of human female hormones. Currently there is not enough evidence to say whether these are superior to the synthetic hormones however anecdotal evidence seems to be more positive

Conclusion

We come back to the original question “IS HRT right for me?” and I hope I have shown you why this is not an easy question to answer. There are so many factors in a person’s medical history, family history, lifestyle and current symptoms which would determine whether it is the right choice for you personally.

If you are looking for a Farnham based osteopath specialising in manual therapy to treat pain or simply want to improve health and wellbeing, please get in touch at enquiries@outlinehealth.com or call 01252 850814.