The pros and cons of hormone replacement therapy for menopausal symptoms
IT STARTED three or four years ago.
I’d forget where I’d put things. I began to wake up in the early hours in sheets soaking-wet and freezing from a series of truly horrendous night sweats.
There was irritability, anxiety, low mood and, over one memorable 18-month-period, I suffered extreme blood loss which resulted in two operations.
I had, though, discounted the possibility of taking HRT because, like many women, I’d heard about the increased risk of cancer and heart disease.
Then, last November, the National Institute of Clinical Excellence (NICE), a body that recommends prescribing and treatment in Britain, issued guidelines on menopause.
A review of the research, according to NICE, showed that for women around menopausal age, oestrogen-only HRT caused little or no change in their risk of breast cancer.
And, although HRT containing oestrogen and progesterone may increase breast cancer risk, it’s still relatively minimal.
Dr Shirley McQuade, medical director of the Well Woman Centre, points to the NICE guidelines on the absolute risk of breast cancer – generally about 22.5 women per 1,000 (2.25%) risk developing it, says McQuade, adding that if a woman embarks on a course of oestrogen-only HRT, which is normally prescribed for women who have had a hysterectomy (the removal of the womb), this risk does not increase.
HRT containing a combination of oestrogen and progesterone does increase the risk, but relatively minimally.
“If you put women on HRT with oestrogen and progesterone for five years, the risk is that 27.5 women per 1,000 (2.75%) will develop breast cancer.”
McQuade has experienced a growing demand for HRT in recent times.
“I think this is because more information is filtering through that HRT is not the “baddie that it was once labelled,” she says.
She finds that, once the risks are explained to peri-menopausal women suffering “horrible symptoms” like night sweats, broken sleep and poor concentration and for whom a decent quality of life is now “a huge issue”, they are often willing to take the risk.
The risk may be higher, if they take HRT long-term, but it falls again once HRT is stopped.
“HRT is a good option,” says McQuade.
"It works really quickly — within two to four weeks someone can go from broken sleep, night sweats and being unable to function normally to returning to normal,” she adds.
For some women, the symptoms can continue for eight years but for others it can go on for up to 18 years — and now, McQuade believes, the debate is focusing more on the issue of whether women can stay on HRT longer.
“HRT does not have to be taken for a limited period of time,” she says.
“There are more choices of HRT on lower dosages now, which enables women to stay on it longer.”
When I caught up with her, consultant obstetrician/gynaecologist Mary McCaffrey was just back from a conference in Italy which discussed menopause and the NICE guidelines.
There has been, she says, a ‘drawing back’ from the previously widely publicised association between HRT and the risk of breast cancer.
Back in 2002, the Women’s Health Initiative, a large study in the United States, caused great concern with its findings that HRT increased the risk of heart disease and almost doubled deaths from cancer — but experts say now that during the study women were give the wrong dose of hormones in the wrong form, and that the study also recruited women over 60 who were overweight, diabetic and from backgrounds that put them at higher risk than normal.
Not long afterwards, the Million Women Study conducted by Oxford University also found HRT increased breast cancer risk — but some experts now believe these studies overstated the dangers.
McCaffrey, who is based at Kerry General Hospital and the Scotia Clinic, is confident about the possibility for doctors to safely allow women stay on HRT longer.
“Very often after five years we review it, and again after 10 years,” she says.
McCaffrey is happy for her patients to transition to lower doses or to swap over to a non-oestrogen-based treatment which can treat hot flushes and night sweats after they stop taking HRT.
“However, many women stay on HRT for a long time,” she says.
“The belief that women can only stay on HRT for a particular period of time is questionable.
“Each case needs to be judged on an individual basis. I have women who will not come off it because they cannot function without it,” she says.
McCaffrey is convinced about the benefits of the treatment: “A review of past research shows that HRT does not cause the increased risk of breast cancer that was previously thought.
“HRT has big benefits. It reduces the risk of cardiovascular disease and stroke if you begin soon after menopause.
“We also know that it has big benefits for brain function — it can improve memory and can reduce the risk of dementia.”
However, she cautions, HRT must be taken in conjunction with positive lifestyle change.
Doctors need to prescribe patients the most appropriate type of HRT for them, she says — treatment comes in the form of tablets, patches and gels — and at the lowest possible levels, while patients must be reviewed regularly.
While there are some women with a predisposition to clots or with a history of breast cancer, for example, for whom this therapy is not suited, it does help a very large group of women.
Modern women can expect to live for up to half their lives post-menopause, she says.
New research shows that women born in 2016 are likely to live to 100 — and they will, naturally, want to live busy, active post-menopause lives.
“HRT is not the only way of doing it and there are alternatives for women — there are other medications and treatments that are suitable — but if women get the best possible medical assessment, their problem can be managed.”
However, conventional HRT is still a poor alternative for Dr Marion Gluck, founder of The Marion Gluck Clinic in London and author of It Must Be My Hormones.
Gluck’s clinic receives between 50 and 70 new patients every week and annually treats some 13,000 patients from all over the world with bio-identical hormone therapy.
Bio-identical hormone replacement therapy involves replacing the body’s natural hormones with hormones that are identical in molecular structure to the hormones women make in their bodies.
“Conventional HRT is a substitution therapy, substituting natural hormones with different synthetic hormones which are not the same as those produced by the human body, and which may have side effects,” says Gluck.
“I consider conventional HRT to be a bad alternative to bio-identical hormone replacement therapy,” says Gluck, a medical doctor who has been on a course of her own therapy for some 15 years.
During an hour-long consultation, patients provide a full medical history, and a history of symptoms, undergo a blood test and a comprehensive hormone profile, and an assessment of their needs.
Following diagnosis, individual prescriptions are then filled out at a special compounding pharmacy (one providing personalised medications).
“The therapy is in the form of trans-dermal creams or lozenges which dissolve in the mouth. Patients can take the treatment for life,” says Gluck, who is currently working on her second book and says patients range in age from 20-somethings to 80-year-olds.
Galway GP, Dilis Clare, who manages the Health & Herbs clinic in the city and also runs clinics in Dublin, Sligo and Galway, uses herbs to tackle a wide range of health problems and offers a range of blends and tinctures.
One of these is the Hormone Support Blend, a mix of about seven different herbs, helps with menopause issues such as hot flushes and night sweats, says Clare.
It is appropriate, she explains, for the one-third or so women who experience moderate to severe symptoms of the menopause and are not on any medication:
“It helps between 60% and 80% of them because it supports the hormone balance in the body.”
She believes HRT has benefits but adds that, no matter what hormones you are on, you will have to stop taking them at some stage.
“For me, the benefits of HRT is that it can keep you comfortable in the short term but you still have to go through menopause when you come off it.
“I occasionally use HRT for women who have lots of health problems. They feel comfortable in the short term on HRT while I am addressing multiple, underlying and associated problems such as digestive issues, chronic constipation or skin problems.”
As for me, well, after my research, I’ve been reconsidering the benefits of HRT. I will be making an appointment with my doctor to discuss the situation, and we’ll take it from there.
* HRT comes in the form of tablets, patches and gels.
: with a combination of oestrogen and progesterone: €12 a month oestrogen only: €10 a month.
Oestrogen-only patch: €15 oestrogen and progesterone patch: €30 GEL: €15 Bio-identical hormone replacement therapy:
* A one-hour consultation and tests at the Marion Gluck Clinic in London costs £500 (€637).
Treatment works out at about £40 (€51) a month.
visit: www.mariongluckclinic.com
* Dr Dilis Clare’s Hormone Support Blend.
A mix of herbs including dandelion root, dong quai, liquorice, motherwort, sage, vervain and black cohosh costs €12.50 weekly.
visit: www.healthandherbs.ie
