Menopause is going to happen to you – either creep up on you slowly or arrive suddenly – and you might not like it. What you are going to need to do at some point is decide what to do about it – something, or nothing? Do you try taking hormones, or not?
Whilst going through menopause (perimenopause) women’s hormone levels can swing dramatically. Getting them more evenly balanced to reduce symptoms is not hard – a process of trial and error sometimes but achievable. And anyway, during our reproductive lives our hormones are not balanced- they are coordinated, but the actual levels are in constant flux.
However, at some point through menopause our bodies stop producing much hormone at all. And then, the real balancing act is the decision whether or not to use hormone replacement therapy (HRT).
Making the decision requires you to be able to make an assessment of your current health, your future health risks and how you want to live and feel as you age (your vision of your future self) against how hormone replacement is going to affect that picture. You need to decide if taking HRT is likely to improve your life.
The stumbling blocks to making an informed decision are that few people have a clear idea of their health risks. This is why you should see a doctor about now, get checked out and have the discussion about your future health. Most doctors are risk averse and wary when it comes to prescribing hormones, particularly since evolving research means that HRT recommendations and guidelines keep changing. Consequently, many women are deterred from using HRT when they really could benefit from it. So try and see a women’s health specialist doctor if you can. The other problem of course is that HRT gets some really bad press. More about that later.
About now you might be thinking how you’ve heard that not everyone has menopause symptoms and that the symptoms are not too bad and don’t last long. So why the big deal? You plan to get through it without help like your mum did. And aren’t there more serious health problems to worry about, like diabetes or heart disease, that affect lots of women? Absolutely right. But then menopause affects every woman, and although menopause is natural, now that we live for an unnaturally long time, that adds up to lots of women affected for lots of years. So we need to tease out whether taking HRT would keep us living not just longer but healthier and happier, because there’s some pretty good evidence that it can.
Imagine your ideal self at 50. You have been blessed with good health and you have worked hard to stay fit and keep your weight under control. The demands of family are less now and career- wise you are at the top of your game. You have a good relationship and sex is enjoyable. You are looking forward to having more time to travel, try new things, be adventurous.
Now think about how menopause, or specifically the lack of hormone that is the result of menopause, might affect your plans:
You will lose muscle mass, strength and endurance. You will lose bone strength. Your weight distribution will alter, changing your shape. You will lose tone and elasticity of the vagina. Your skin and hair will become dry. These things will happen. HRT can help prevent this.
You might also get joint and muscle aches and pains; headaches; not sleep well anymore; get hot flushes; sweat excessively; feel vaginal dryness and discomfort; have pain with sex; lose interest in sex and the ability to climax; have reduced bladder control; and experience irritability, low mood or anxiety. Your big risks are osteoporosis and pain; reduced capacity for exercise; loss of sexual relationships; and loss of confidence and sense of self. And this is in a perfectly healthy woman! HRT can prevent this.
Now superimpose on that picture your fear or risk of having Alzheimer’s and memory loss, bone fracture, heart disease, uterine cancer, bowel cancer or diabetes. The research has been done- HRT reduces your chance of all of these. Good news!
What you will often see and hear in the media is bad news. Understandably women’s greatest fear is breast cancer. It is so common that we virtually all know someone who has been affected. But the media should not be relied upon for information. Your chance of having breast cancer around the age of menopause is 3:1000 and is increased to 4:1000 when you use HRT- a small increase.
Put it all together and the benefits of using HRT far outweigh the risks – in healthy women.
We need to reverse our approach to the question about using HRT during and after menopause. Given the proven health benefits of HRT and the fact that women at 50 and up want to stay involved with the world and live active lives, the question should be
“Why would I not use HRT?”
# You don’t want to take it or are unsure.
You need to get good information about what the benefits of HRT can be for you and what the risks might be. This is where women can stumble. We have so many dodgy products marketed to us with health claims of questionable veracity, it can get confusing. I would recommend that you talk to a women’s health doctor or gynaecologist, or check out the Jean Hailes website for detailed information about menopause and HRT. https://jeanhailes.org.au/health-a-z/menopause
# You are not sure that you really need it.
You may not feel that your symptoms are bad enough to warrant taking HRT. Remember that, for healthy women, using HRT is extremely low risk and of great benefit. But healthy women feel healthy, and so you may decide that you want to wait and see if you get any problems and then take HRT if you do. That’s fair enough, but any gynaecologist will tell you that once you have a problem, like pain with sex for instance, it’s harder to fix than to prevent in the first place. And of course if you are unlucky enough to get Alzheimer’s, osteoporosis or heart disease, you’ve missed the prevention train and you’re stuck with the problem- HRT is no help then.
# You don’t like to take medication.
There are a number of different ways to take HRT and they are all convenient and easy. Focus on the benefits.
# You’re worried that once you start taking it you will not be able to stop.
For all users of HRT the decision to continue should be regularly reviewed with your doctor. And you can stop using HRT whenever you want. You may experience hormone deficiency symptoms if you stop, but less if you wean off slowly and less if you do it when you’re a bit older. Your doctor can help you through this process. Taking HRT is not delaying menopause- your menopause happens when it happens- it is softening the symptoms and delaying the effects on the body.
# You are worried about the risk of taking HRT for a long time.
Then maybe think about using it as an extender. You would have at least delayed the onset of problems for the duration that you use HRT. Plus if you use HRT for 5 years, there is virtually no increased risk of breast cancer and if you use HRT for 10 years, the increased risk of breast cancer is very small.
Once you stop taking HRT any increased risk of breast cancer reverts to the normal risk.
# You have health problems.
You should not use HRT if you have heart disease, blood clots or are at risk of, or already have had breast or uterine cancer. You should talk to your doctor to discuss how to manage your risk.
Finally, remember that you have an increased risk of breast cancer if you have more than 2 standard drinks per day, are overweight, had your first child after age 35, or have a late menopause. A couple of those things we can fix ourselves!
I hope that all women in our community have access to good information about health and menopause. Remember, for most women the benefits of HRT outweigh the risks and the time for prevention is now.
Good luck with your decision and we’re here if you need us!
Melissa