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Hormone Replacement Therapy - The Facts

What is the difference between Peri-Menopause and Menopause?

It’s important to understand the difference between peri-menopause and menopause.  I’d like to say that peri-menopause is your body's way of gently leading you into the next stage of life, but let’s face it, there is nothing gentle about it! 

Peri-menopause can start as early as ten years before you are in full menopause, which is why it’s so easy to misdiagnose. The menopause itself occurs when the ovaries finally stop producing eggs altogether and is judged to be complete when a woman has not had a period for 12 months. The symptoms that cause so many women difficulty generally occur during the peri-menopause - the years leading up to full menopause.

We often hear stories where women feel they are too young to go through the menopause which makes it easier for us to accept it when a doctor diagnoses us with simple depression or anxiety, mistaking the symptom for the problem.

Paying attention to your body and knowing the signs can help you stand your ground if you seek medical advice. 

Here's a reminder of some of the main symptoms:

  • Changes in regularity, duration and heaviness of periods
  • Passing blood clots
  • Hot flushes (flashes)
  • Night sweats
  • Fatigue 
  • Problems sleeping
  • Reduced libido
  • Problems with memory and concentration
  • Mood swings/unstable mood
  • Emotional outbursts of anger, grief and other strong feelings
  • Irritability
  • The need to urinate more frequently and more urgently
  • Vaginal dryness
  • Discomfort during sex
  • Breast tenderness
  • Changes in breast size
  • Headaches
  • Anxiety
  • Depression
  • Suicidal feelings
  • Palpitations
  • Joint stiffness, aches and pains
  • Aching muscles
  • Reduced muscle mass
  • Tendency to urinary tract infections (UTIs)
  • Increased risk of developing osteoporosis
  • Itchy skin
  • Feeling faint
  • Brain fog/loss of concentration
  • Loss of confidence
  • Weight gain - especially hard to shift fat around the middle
  • Bloating
  • Hair loss
  • Dry skin

Seeking Help

Symptoms vary from woman to woman and I can’t stress enough how important it is to seek help if things are getting too much. Mental health changes are common. You are going through a major change and your hormones can become severely unbalanced. Some women report suddenly feeling suicidal, even though they have never had any previous problems with their mental health. If this is you, see your doctor sooner rather than later. 

There are several ways to treat or help with the Menopause. HRT (Hormone Replacement Treatment) being the most commonly heard of. However, there are natural alternatives and it’s about finding the right treatment for you. 

A great starting point is the NHS website where they explain ways to treat the symptoms individually. Be aware, though, that the term "menopause" is used interchangeably with peri-menopause, which does not appear on the site. There are, of course, alternative resources available, however, I would recommend, first and foremost, discussing the options with your GP s that you can make informed choices.

According to the guidelines issued by The National Institute for Health and Care Excellence (NICE), a FSH (Follicle Stimulating Hormone) test should be administered to women 40-45 with peri-menopausal symptoms.  After 45, diagnosis will be made by looking at symptoms.

It’s unlikely you will be offered any treatment at this stage unless your symptoms are particularly troublesome. However, if your quality of life is compromised, once you have been officially diagnosed, you are likely to be offered HRT.

HRT (Hormone Replacement Treatment) - the Facts

HRT is a treatment offered to women to reduce the symptoms of the peri-menopause. It replaces some of the hormones that are at a lower level as you begin this cycle of your life. 

Over the years, there have been reports and rumours around the effects of the treatment. There are pros and cons to using it but it’s about your own personal circumstances and what’s right for you. 

HRT can replace two hormones: Oestrogen and/or Progesterone (which is replaced with a synthetic version called progestogen) .

HRT will involve either taking both hormones (Combined HRT) or just Oestrogen. Most women will be advised to take the Combined HRT as Oestrogen on its own can increase your risk of womb cancer. Oestrogen only HRT is usually only recommended to women who have had their womb removed. 

The Risks vs Benefits

HRT has been associated with some forms of cancer. There is still a huge amount of research being done on this subject and NICE currently take the stance that the risks are very small. You can see the current statistics below. 

It’s about making an informed decision based on your personal circumstances, research and advice from your GP. 

Benefits can include:

  • A decrease in symptoms, improving your quality of life 
  • A reduced risk of Cardiovascular Disease
  • The risk of developing Osteoporosis will decrease

Risks to consider include:

  • Breast cancer – Approximately 5 extra cases in 1000 women are diagnosed due to using Combined HRT (0.5%)
  • Ovarian cancer – Approximately 1 extra case in 1000 women are diagnosed due to using Combined HRT (0.1%)
  • Womb cancer – There is a significant risk if taking Oestrogen HRT only. That risk is decreased if taking Combined HRT. Oestrogen only would normally only be recommended to women who have been through a hysterectomy 
  • Blood clots – If taking in tablet form, there is an increased risk of developing DVT. However, in 1000 women taking Combined HRT for 7.5 years, less than two will develop this condition (0.2%)

Possible Side Effects:

  • bloating
  • breast tenderness or swelling
  • swelling in other parts of the body
  • nausea
  • leg cramps
  • headaches
  • indigestion
  • vaginal bleeding
  • mood swings
  • depression
  • acne
  • stomach pain
  • back pain

According to the NHS, side effects should subside after a few weeks.

There are certain circumstances in which HRT is unlikely to be suitable. If you fall into one of the following categories, you will need further discussions with a medical professional to decide if this is the right path for you:

  • A family history of Breast Cancer, Ovarian Cancer or Womb Cancer
  • A history of blood clots
  • Untreated high blood pressure. This will need to be controlled before commencing treatment
  • Have liver disease
  • Are pregnant (It is still possible to get pregnant during peri-menopause)

How can you take HRT?

There are several ways to take HRT and you will need to discuss with your GP the pros and cons of each:

  • Tablets
  • Skin patch
  • Oestrogen Gel
  • Implants
  • Vaginal Oestrogen

Each have their own risks and advantages so it’s important to learn the facts first. The NHS website provides information on each

There are, of course alternatives to HRT.  From natural remedies, diet and exercise to other prescribed medication. There is no hard evidence that these are a good alternative, but that’s not to say they don’t work. We will be looking at some of these in future blog posts.

The bottom line is, take rumours with a pinch of salt, do as much independent research as you can and make a decision based on what fits with you and your lifestyle. There are risks to everything in life - only you can decide how life limiting your peri-menopausal symptoms are. Try alternatives, talk to your GP and come to a conclusion that feels right for you and your body. 


Note: This article is based on treatment offered in the UK - other country's protocols May differ.


HRT: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/ 

NICE Guidelines: Menopause: Diagnosis and Management https://bit.ly/2GhmEPE

Symptoms of the Peri-menopause: https://www.themidlifemovement.com/blog/peri-menopause-the-symptoms

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