Theres a lot of information to take in. So its OK to discuss options for managing your menopausal symptoms over several consultations with your GP.
We have seen increasingly dramatic headlines over the years on the risks of menopausal hormone therapy (MHT), also known as hormone replacement therapy.
An alarming study in 2002, which found an apparent increased risk of breast cancer in women who took MHT, prompted the first of these headlines.
But newer evidence has been reassuring. Its also a reminder that when considering your options, any risk associated with taking MHT needs to be balanced with the benefits.
This balance is the main thing your GP will consider when discussing whether MHT is right for you.
Read more: Making sense of menopausal hormone therapy means understanding the benefits as well as the risks
In 2002, the Womens Health Initiative study found women who took MHT had a 26% increased risk of breast cancer. This finding, which was later disputed, led to a 55% drop in MHT use in the next three years.
A reanalysis of the data showed a lower risk of breast cancer in some women.
And in 2016, a statement from the worlds leading menopause specialists said the benefits of MHT are more likely to outweigh the risks if women with symptoms start taking it before they turn 60 or within ten years after menopause.
Read more: What causes breast cancer in women? What we know, don't know and suspect
Then a study published in The Lancet in recent months suggested the risks might be greater than once thought.
However, this study combined the results of previous ones, including observational studies, which have limitations. Observational studies show associations between one factor and another, rather than one causes the other. So factors other than MHT might be at play in increasing a womans risk of breast cancer. As a result, these studies tend to overestimate the risks.
Other risks linked with MHT include thromboembolism (a type of blood clot). And in older women, theres an increased risk of stroke.
So, if you are one of approximately one-third of women aged 40-65 suffering moderate to severe menopausal symptoms, what do you need to know?
Most women experience menopause (the date of her last period) at around 45-55 years of age. Some womens periods stop before then, either spontaneously or due to some medical treatment, with varying symptoms and health risks.
However, menopausal symptoms may start before periods stop, and last on average seven to ten years. For a minority of women, symptoms can last for longer.
Physical symptoms include hot flushes, night sweats and vaginal dryness, with severe symptoms profoundly reducing womens quality of life.
MHT is available in different forms such as a tablet, skin patch, gel, and vaginal pessary or cream. These have advantages and disadvantages.
For example, some act on the whole body such as tablets, gels, and patches while others such as vaginal creams and pessaries act on the local area only. Those that act locally have no increased risk of breast cancer or thromboembolism.
Read more: Don't count on freezing ovarian tissue to delay menopause or stop your biological clock
MHT is an effective treatment for hot flushes, night sweats and vaginal dryness. Other treatments, such as bioidentical or natural hormones, have safety concerns. Others, such as phytoestrogens and many other herbal preparations, dont work.
MHT also helps prevent osteoporosis, and may help prevent colon cancer, type 2 diabetes and coronary heart disease.
The balance of risks versus benefits of MHT varies from woman to woman, depending on a number of factors. Here are some hypothetical examples.
1. Gina is a healthy 52 year old with menopausal symptoms, a family history of breast cancer (her mother was diagnosed at 65), and low bone density
If Ginas menopausal symptoms are troubling her, then MHT is a reasonable option. Not only is it the most effective treatment for her symptoms, it has the added benefit for bone health. Gina will need a comprehensive assessment to decide the best type of MHT.
Breast cancer is the most feared risk of MHT. The risk depends on the type of MHT and how long its used. But that risk declines after Gina stops using it.
The Lancet paper showed that for women with a family history of breast cancer like Gina, MHT use does not further increase her breast cancer risk. But it also showed that longer use of MHT is associated with a slower decline in risk after stopping using it.
2. Sarah has menopausal symptoms, has had both ovaries removed and a hysterectomy, is obese and drinks moderately
Sarahs going through whats called a surgical menopause and has the physical symptoms that go with it, including hot flushes.
Her obesity and moderate drinking already increases her risk of breast cancer. The Lancet paper showed that the use of oestrogen only-MHT (the type of MHT shed take because of her hysterectomy) does not further add to this risk.
However, her obesity is associated with an increased risk of blood clots. As the risk of blood clots increases if she takes oestrogen in tablet form, MHT as a skin patch or gel would be the best choice.
Losing weight may also improve Sarahs hot flushes.
3. Sam went through menopause before she turned 45
One in 10 women experience menopause before the age of 45, like Sam.
This puts her at a 30% lower risk of breast cancer compared with women who experience menopause later in life.
However, early menopause is associated with a greater risk of premature death, including from heart disease as well as substantially greater risk of osteoporosis and fragility fracture in later life.
So her GP will likely advise her to take MHT until the average age of menopause. This restores her breast cancer, heart, and mortality risk to approximately what it would have been if she had not gone through an early menopause. It also reduces her risk of bone thinning (osteoporosis).
4. Lee is 65, has vaginal dryness but no more hot flushes
Vaginal symptoms, including discomfort from vaginal dryness, are common in postmenopausal women like Lee. And vaginal oestrogen preparations as a pessary are an effective and safe option.
Vaginal oestrogen acts locally so does not improve bone health and does not increase blood clots or breast cancer risk.
The decision about whether to use MHT, which form, or to consider an alternative to MHT to manage your symptoms can be a complex one.
So, its important to form a partnership with your doctor who can guide you to make an informed decision. You may need several discussions over a period of time to fully consider what is right for you.
See the original post here:
Thinking of menopausal hormone therapy? Here's what you can expect from your GP - The Conversation AU
- Bio Identical Hormone replacement therapy "alternative medicine" OMT - June 1st, 2010 [June 1st, 2010]
- Healthbeat - Hormone Replacement Therapy - August 5th, 2010 [August 5th, 2010]
- Does Hormone Replacement Therapy increase breast cancer risks? - August 11th, 2010 [August 11th, 2010]
- Hormone replacement therapy increases risk of cancer - October 20th, 2010 [October 20th, 2010]
- Hormone Replacement Therapy Risky For Women - October 20th, 2010 [October 20th, 2010]
- Can Hormone Replacement Therapy Lead To Breast Cancer? - January 31st, 2011 [January 31st, 2011]
- Women Turning To Holistic Hormone Replacement Therapy - February 18th, 2011 [February 18th, 2011]
- Is Hormone Replacement Therapy Dangerous? - March 17th, 2011 [March 17th, 2011]
- Hormone Replacement Therapy Complications - May 8th, 2011 [May 8th, 2011]
- Hormone Replacement Therapy - May 10th, 2011 [May 10th, 2011]
- The New Growth Hormone Replacement Therapy - John Crisler, DO - May 13th, 2011 [May 13th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 2 of 6 - May 20th, 2011 [May 20th, 2011]
- Symptoms of Menopause (Menopause #2) - May 20th, 2011 [May 20th, 2011]
- How to Relieve Menopause Symptoms : Hormonal Replacement Therapy for Menopause - May 20th, 2011 [May 20th, 2011]
- HRT - Hormone Replacement Therapy - May 20th, 2011 [May 20th, 2011]
- What is hormone replacement therapy? - May 20th, 2011 [May 20th, 2011]
- Hormone Replacement Therapy and Breast Cancer - May 20th, 2011 [May 20th, 2011]
- Natural Treatments Instead of Hormone Replacement Therapy - May 20th, 2011 [May 20th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 1 of 6 - May 23rd, 2011 [May 23rd, 2011]
- Hormone Replacement Therapy for post-menopausal women - June 19th, 2011 [June 19th, 2011]
- Joe Rogan talking about hormone replacement therapy 6-14-2011 - June 25th, 2011 [June 25th, 2011]
- Hormone Replacement Therapy and Weight - June 25th, 2011 [June 25th, 2011]
- HRC Hormone Replacement Therapy - June 25th, 2011 [June 25th, 2011]
- Study Hormone Replacement Therapy Increases Breast Cancer Risk - kdka.com - June 25th, 2011 [June 25th, 2011]
- 020 - Neo Hormones - July 1st, 2011 [July 1st, 2011]
- Making Sense of Hormone Replacement Therapy - July 28th, 2011 [July 28th, 2011]
- HRT MTF Transition Report Week 10 - July 29th, 2011 [July 29th, 2011]
- Hormone Replacement - Part 2 - July 30th, 2011 [July 30th, 2011]
- Hormone Replacement - Part 1 - July 30th, 2011 [July 30th, 2011]
- Goldie Lookin Chain - HRT - August 9th, 2011 [August 9th, 2011]
- Natural Hormone Replacement Therapy - September 23rd, 2011 [September 23rd, 2011]
- Testosterone Replacement Therapy (TRT): Optimizing Clinical Outcomes - Michael Aziz, MD - September 24th, 2011 [September 24th, 2011]
- Thyroid Replacement Therapy - Ronald Rothenberg, MD - September 24th, 2011 [September 24th, 2011]
- Dr. Ralph Turner discusses Hormone Replacement Therapy. - September 24th, 2011 [September 24th, 2011]
- 1 year on HRT - September 24th, 2011 [September 24th, 2011]
- The Wiley Protocol - September 24th, 2011 [September 24th, 2011]
- My Journal with Low Testosterone TRT Replacement Therapy - September 24th, 2011 [September 24th, 2011]
- 12 years of HRT: My Transition in photos - September 24th, 2011 [September 24th, 2011]
- Dr. Steven Jepson talks about Bio-identical Hormone Replacment Therapy - September 25th, 2011 [September 25th, 2011]
- Estradiol Valerate Injection HRT (Part 3)of(3) - September 25th, 2011 [September 25th, 2011]
- Study: Post-Menopausal Hormone Therapy Increases Cancer Risk - September 25th, 2011 [September 25th, 2011]
- Bio-identical Hormone Replacement (anti-aging) Therapy - Westchase, Tampa, Florida - September 25th, 2011 [September 25th, 2011]
- natural hormone replacement - September 28th, 2011 [September 28th, 2011]
- 6 Month Hormone Effects (before and after) - September 28th, 2011 [September 28th, 2011]
- Jeff Life, MD - Cenegenics, Hormone Replacement Therapy - September 29th, 2011 [September 29th, 2011]
- Huge - September 30th, 2011 [September 30th, 2011]
- Transsexual hormones,Intramuscular injection, Progynon Depot,Estradiol - October 2nd, 2011 [October 2nd, 2011]
- Dr Whiting on Menopause and the Dangers of HRT - October 12th, 2011 [October 12th, 2011]
- Ahuviya Harel (ADF-Fuensalida) to Start Hormone Replacement Therapy - October 13th, 2011 [October 13th, 2011]
- Clomid Defined - Video - October 14th, 2011 [October 14th, 2011]
- Thyroid Hormone Replacement Therapy - Dr. Denis Rebic - Video - October 14th, 2011 [October 14th, 2011]
- Hormone Replacement Therapy - Video - October 14th, 2011 [October 14th, 2011]
- Dr. Pamela Smith - Bio-Identical Hormone Replacement - Video - October 15th, 2011 [October 15th, 2011]
- Jasper Carrott - Traffic - October 22nd, 2011 [October 22nd, 2011]
- VIDEO: Breast Cancer, Hormone Replacement Therapy Connection - Video - October 24th, 2011 [October 24th, 2011]
- Menopause and Hormone Replacement Therapy with Dr. Sulak - Video - October 24th, 2011 [October 24th, 2011]
- Menopause - October 24th, 2011 [October 24th, 2011]
- bio identical hormone replacement therapy raleigh durcham chaepl hill north carolina - Video - October 24th, 2011 [October 24th, 2011]
- Endocrine Related Hair Loss, Can Hormone Replacement Therapy Help Treat This? Friedman - Video - October 24th, 2011 [October 24th, 2011]
- Dr. Navarro Discusses Bio Identical Hormone Replacement Therapy - Video - October 24th, 2011 [October 24th, 2011]
- Hormone Replacement Therapy by the Book - Eldred Taylor, MD - Video - October 24th, 2011 [October 24th, 2011]
- Sangeeta Pati, MD, FACOG, discusses Hormone Replacement - Video - October 24th, 2011 [October 24th, 2011]
- Active Center's Dr. Gross Discusses Bio-Identical Hormone Replacement Therapy on NEWS 12 NJ - Video - October 28th, 2011 [October 28th, 2011]
- DALLAS ANTI-AGING MEDICINE BIO-IDENTICAL HORMONE THERAPY - Video - October 29th, 2011 [October 29th, 2011]
- Hormone Replacement Therapy and Menopause in Women - Video - November 8th, 2011 [November 8th, 2011]
- Amberen - Natural HRT Alternative Commercial - Video - November 9th, 2011 [November 9th, 2011]
- The Dangers of HRT - Video - November 11th, 2011 [November 11th, 2011]
- The Benefits and Risks of Male Hormone Replacement Therapy - Video - November 16th, 2011 [November 16th, 2011]
- Natural Menopause Treatment - Herbal HRT Alternative - Video - November 23rd, 2011 [November 23rd, 2011]
- Dr. Ian Thorneycroft - Hormone Replacement Therapy - Video - November 24th, 2011 [November 24th, 2011]
- Sarah,MTF Transgender 3months HRT - Video - November 24th, 2011 [November 24th, 2011]
- 26. ftm 1 month on t - Video - November 24th, 2011 [November 24th, 2011]
- Dr. Quint Jardine - Hormone Replacement Therapy with Pellets - Video - November 24th, 2011 [November 24th, 2011]
- 6 Month Changes MTF HRT - Video - November 24th, 2011 [November 24th, 2011]
- Medical Mondays: Will hormone replacement therapy increase my risk of breast cancer? - Video - December 6th, 2011 [December 6th, 2011]
- HRT EXPERIENCES NOT ALL GOOD - Video - December 8th, 2011 [December 8th, 2011]
- Sarah, MTF transgender 9 months HRT - Video - December 9th, 2011 [December 9th, 2011]
- Full: Effect of Testosterone Replacement Therapy on Prostate Tissue in Men with Late-Onset Hypogonadism (Dramatic Health) - Video - December 10th, 2011 [December 10th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 3 of 6 - Video - December 11th, 2011 [December 11th, 2011]
- 1 Year HRT MTF Transition - Video - December 12th, 2011 [December 12th, 2011]