Why NOT taking HRT could kill you

HRT is a safe, effective treatment for perimenopausal hot flushes and night sweats… it could even be protective!

Hormone Replacement Therapy (HRT) received a lot of bad press in the noughties. Menopause experts have spent almost two decades now trying to revive its reputation as a safe and useful treatment for hot flushes. If you remain unconvinced though, perhaps this will make you reconsider: HRT could also help you live a longer, healthier life!

Sweaty Bettys like me who explore the treatment options for hot flushes will hear plenty of strongly-worded opinions on the subject of HRT both in the media and the tearoom. It’s a polarising subject; women either love it or hate it depending on what they (or their relative/friend/neighbour) have read/ heard/experienced. The scientific evidence very clearly indicates that HRT is safe and beneficial for the majority of women who are within a few years of their last menstrual period. So why is the subject so controversial? Two words: BAD PRESS.

Last year I was privileged to attend some talks by Dr Robert Langer, a Principal Investigator on the huge Women’s Health Initiative (WHI) study of the late 1990’s in the US. He explained how some bad outcomes amongst older women during the study were incorrectly generalised to the younger group of newly-menopausal women. The data was released in a misleading and sensationalised way that terrified a generation of women into believing the HRT they’d been taken was dangerous, and left a legacy of fear that we have yet to overcome.

Sadly this misinformation caused hundreds of thousands of women with dreadful menopausal symptoms to suffer needlessly. Even worse, a decade after the shunning of HRT there was a significant jump in heart disease mortality rates for women across the US compared to men. Could these things possibly be linked?

Is HRT safe?

Firstly, let me give you the unequivocal facts about the safety and effectiveness of HRT, or MHT (Menopausal Hormone Therapy) as it’s also known:

• Estrogen therapy is the most effective treatment option for menopausal hot flushes.
• Hormonal therapy is safe for use in most perimenopausal women, that is women who are pre-menopausal or within a few years after menopause (their last period).
• It is safe for most of these women to continue using HRT for as long as it’s needed provided they do not take long breaks off it.
• Some forms of HRT are safer than others. For example, estrogen taken orally can increase your risk of unwanted blood clots, whereas estrogen via a patch or cream (transdermally) does not.
• Some types of progestins used in HRT are also safer than others; some can slightly increase your breast cancer risk after five years of use, but there are other types available which do not have this effect.

So HRT is definitely worth considering if you have awful hot flushes or night sweats. It can also help with many other common menopausal symptoms such as mood changes, sleep disturbance, vaginal dryness, urinary problems and sexual difficulties.

Is HRT beneficial?

What you may not know is that there can be a number of other long-term health benefits for women who do choose to use HRT for their flushes, depending on the type used:

• Reduced rates of heart disease
• Stronger bones
• Reduction in diabetes rates
• Reduced rates of colorectal and uterine cancers
• Reduced breast cancer risk, and
• Possibly reduced rates of Alzheimer’s dementia (although data is limited)

Firstly, let me explain how these conclusions were reached. The WHI study was actually set up to study the health of women well past menopause, not really the age when you would normally start HRT. When the data was re-examined ONLY for women who started HRT under the age of 60 it showed that not only was HRT safe, it also had some unexpected longer-term health benefits.

IF YOU’VE HAD A HYSTERECTOMY and are suffering with hot flushes you can treat them with estrogen alone rather than “combined” HRT. This is because you don’t need a progestin to protect your uterus against endometrial cancer.

The evidence from the WHI study very clearly demonstrated that for women who started estrogen-only HRT under the age of 60 there were reduced rates of coronary heart disease, diabetes, breast cancer, death, and a HUGE reduction in bone fractures.

IF YOU HAVEN’T HAD A HYSTERECTOMY and decide to use HRT you will require both estrogen and a progestin, to stop the lining of the uterus from becoming abnormally thickened. The WHI evidence for women who started combined HRT before age 60 showed reduced rates of diabetes, bowel and uterine cancers, death, and again a huge reduction in bone fractures.

Get expert advice!

As you can see, the benefits of HRT vary depending on which hormones you need, and the risks also vary depending on the particular type and delivery system of hormones chosen. Also, remember that these results are statistics about a large group of people; they can’t always be applied to an individual with their own specific medical issues. For example, if you’ve had breast cancer then most forms of HRT will be unsafe for you, although your symptoms can be managed using a range of other treatments.

The important take-home message is this: if you are putting up with dreadful hot flushes because you think HRT is unsafe then please get some evidence-based advice from a doctor who is knowledgeable about menopause treatments. You could be denying yourself some important long-term health benefits by not starting HRT early, as well as enduring symptoms that might be easily treated (and who knows how long they might last!)

If you can’t find a health professional who is confident in treating your hot flushes then book a Telehealth consultation with an expert WellFemme menopause doctor.

Click here for an evidence summary about HRT by the Australasian Menopause Society.