Menopause and HRT: myths and misconceptions.
There are about as many myths and misconceptions surrounding HRT as there are symptoms of menopause. Here gynaecologist Vikram Talaulikar runs through some of the most common ones.
Q. HRT will make me fat
“That’s definitely a myth. I’ve seen many women on HRT go both ways. I’ve seen women starting HRT who’ve put it on and just as many who’ve lost weight or seen no changes. It’s very individual. From the studies we know that it doesn’t make you put on weight but what it can do in the first few months is make you feel bloated and that’s because both oestrogen can progesterone may make you retain fluid, so you may notice and increase in weight because of water retention. In addition you may feel bloated but that may usually disappear over 3-6 months. The patches or gels tend to be better in this regard.
It’s important to look at lifestyle factors too – diet, exercise and so on.”
Q. HRT will give me cancer
“No, not true. If you’re healthy, don’t have a background genetic risk of breast cancer and are under the age of 50-60 the benefits far outweigh the slight increase in the risk of cancer. HRT actually reduces the risk of colon cancer. The one we worry about if the risk of breast cancer. Some studies assert there is a high risk and others that say not such a high risk – it’s controversial. What we do know is that of the 1000 women who take HRT somewhere between 5-10 may go on to develop cancer. The risk is far, far higher if you are a smoker, are overweight, don’t exercise or drink too much alcohol. So it’s important to concentrate on reducing all the other risk factors. In the end it’s an individual decision.”
Q. I can’t start HRT if I’m over 55
“Yes, you can. If you’ve starting to experience menopausal symptoms then yes you can start. The majority of the benefits come under the age of 60, so if there are no other medical reasons to stop you from taking it, you can start it.”
Q. I can’t have HRT if I have high blood pressure
“No, wrong. As long as the blood pressure is controlled you can take it. High blood pressure is an individual risk factor for having a blood clot or a stroke, but as long as your blood pressure is under control you can have HRT.”
Q. I can’t get pregnant if I’m using HRT
“No, that’s not true. HRT is not contraceptive, so it is possible that you can still release an egg and ikf that happens there’s 5-10% chance you can conceive so you must use contraception if you’re on HRT and haven’t yet reached menopause (ie no period for 12 months.)”
Q. I can’t be prescribed HRT if I’m still having periods or have heavy or irregular periods
“If you’ve ruled out any underlying causes for heavy or irregular periods you can take cyclical HRT – one that gives you a period.
And if the periods are heavy you can take medications to reduce the bleeding or get a mirena coil that can help reduce bleeding and take oestrogen in addition to that as a gel, patch or tablet.”
Q. HRT delays menopause
“No, HRT doesn’t – it simply replaces the hormones you’re missing in the body and you will reach menopause at exactly the same time as you would have without the oestrogen and progesterone that is replacing what you are missing. It doesn’t delay it.”
Q. I must have a blood test to diagnose menopause
“No, these days blood testing plays a minimal role in diagnosing menopause. Same with DUTCH testing. [Dried Urine Test for Comprehensive Hormones]. The only time we really do blood testing is if you’re below 40 years of age or if there are other things we’d like to rule out as causes of the symptoms. When I’m asked about the DUTCH test I think that is that tests like this give you so much information about a myriad of hormones and claim that by tweaking them they can improve your health. I’m not sure there is any value in this and I think it’s best to stick to what is proven, required and evidence-based. You’ll save money that way too.”
Q. Bio-identical hormones are safer than HRT
“No, bio-identicals come from plants and are generally made by high street clinics or compounding pharmacies. They can be quite effective as they’re replacing the missing oestrogen and progesterone, but the difficulty is that we don’t know about the long term safety profile. Body-identical HRT is what we use as the ‘regulated HRT’ which contains natural oestrogen and progesterone obtained again from plant sources, and these have been well studied in large, randomised, controlled trials over many years and we know exactly what they do in the long term in terms of risks of blood clotting or breast cancer. So I’m confident that you’ll probably be safe taking these hormones rather than the bio-identical where I can’t be sure about the safety of them.”
Q. HRT will give me diabetes
“No, the opposite is true, it may actually help you control it. But is it important that you have your diabetes under control before you start it and that you don’t have any other co-morbidities like high blood pressure that aren’t under control as well. Once those are controlled you may find the HRT helps you control it.”
Q. Natural supplements are safer than HRT
“No, but again it’s an individual choice. If you are trying some herbal or other supplements and you are getting some benefit then by all means continue to take them. But, what we don’t know is the longer term safety of some of these as they haven’t been studied. HRT is well studies and is known to be beneficial.
So some of these herbal remedies may be marketed as being safer but we don’t know about the longer term effects – they haven’t been subjected to the rigour of scientific study. I don’t stop my patients from taking them, but I’d suggest HRT is a known quantity.
What I would say is good to take is Vitamin D, Magnesium to help with energy and cognition, calcium – but that’s best in natural dietary intake, and folic acid if you have issues with clotting. Soy and tofu may help too.”
Q. I’ll have to stop taking HRT after 5 or 10 years or once I reach 60
“The concept that you had to stop taking HRT after 5, 10 or 20 years is no longer valid now. What we know at the moment is that as long as you are keeping your risk factors low – that is for breast cancer, heart disease and blood clotting, you can safely take HRT for as long as it gives you benefits for your symptoms, your bone health, your brain health and your heart health. If you’d like to continue HRT then keep going but you should have an annual review to assess how much benefit you’re getting, how do you feel if you come off it- do you feel terrible etc – that will be the key.
We know the risk of HRT is dependent on age – after early 50’s there is a slight increase in risk for breast cancer. Many women don’t want to take that risk and I advise them to slowly come off it and take a break and see how they feel after 3 months without it. Some women will find they feel fine and no longer continue. But other women will find their symptoms return and they prefer to continue. It is of course best to be on the lowest dose that can effectively control your symptoms.”
Q. I can go cold turkey when I come off HRT
“When you come off it’s best to come off slowly so you don’t have a rebound effect. Try halving your dose for a few months and then halve it again and gradually come off over a few months.”
Q. Heavy bleeding/clotting is common during perimenopause
“Yes and No. Most women will have changes in their periods – irregular or heavy bleeding around perimenopause. The cycles can space out or become more frequent around the age of 45-47. They can start to notice that they are lighter or much heavier and there may be clots. That’s usually a sign that they are becoming ‘anovulatory’ – that means an egg has not been produced, so it takes longer between cycles so there is thickening of the lining of the endometrium and they can start to notice clots. If this heavy bleeding lasts for more than 6 months and it doesn’t settle down or your periods don’t stop you would want to know that there are no co-existing conditions like fibroids or adenomyosis which can sometimes cause heavy bleeding. All of these usually occur in the 40-50’s and may need to be dealt with.
If there are no other underlying causes then it comes down to management. Tablets like tranexamic acid can be used to control the bleeding or the mirena coil – a progesterone coil – that is inserted into the womb is another good option to help control the bleeding.”
Q. Can you have HRT if you have Lipoedema?
“This isn’t a common condition. The difficulty is that we don’t know enough about the level of oestrogen triggers it. If it has developed as a result of taking HRT it could be that the person is very sensitive to the type of oestrogen being used so you may want to swap to another or stop altogether.
If the lipoedema is already there then you may want to go on HRT because the lack of oestrogen could be fuelling the lipoedema and when you start the HRT it may become better, so I would certainly recommend starting it – depending on the rest of your medical history.”
You can read more about Gynaecologist Vikram Talaulikar by clicking here.