There are many knowledge gaps for women when it comes to menopause and perimenopause. And a lot of scaremongering out there, particularly around the issue of HRT. Which is why we asked Dr Stephanie Goodwin to explain the facts, not the fictions. If you want to know what is hormone replacement therapy (HRT), then this video answers all your questions.
What is hormone replacement therapy (HRT)?
Below is a full transcript of Dr Steph’s brilliantly informative video advice.
What is HRT?
HRT is Hormone Replacement Therapy. It’s putting back a little bit of what was there before, and the key to this is that it’s using small amounts of hormones. So we use oestrogen, we use progesterone, and increasingly now we use testosterone for women.
What are the benefits of HRT?
I love talking about the benefits of HRT because nobody ever talks about them, which is a shame because there are so many.
The immediate benefit for women is that you feel so much better. If you’ve been waking up every night lying in a pool of sweat like I was and you start using HRT and then you can sleep, then that’s transformative.
So symptom relief is really important. But there are other longer term benefits. For example, one of the most important things that women don’t know about, is the thing we’re most likely to die from is heart disease. We’re seven times more likely to die from heart disease than we are from breast cancer. From the age of 40, the risk of death from heart disease is much higher than it is from breast cancer until the day we die. HRT has been shown to reduce the risk of heart disease by up to 50%.
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HRT protects your bones. Women die of osteoporosis when they get much older, it’s a very common cause of death within the first year of a hip fracture.
HRT reduces the risk of bowel cancer by 30%, did anybody ever tell you that? I’m sure not, I certainly didn’t know that.
So there are many health benefits; it improves your vagina, it improves your libido. Women who take HRT have a lesser risk of all-cause mortality, so dying from all causes, than women who do not take HRT. So these are very important facts.
What are the risks of HRT?
The risks of HRT actually are extremely small and are far outweighed by the benefits.
One of the risks is that if you take your HRT as a tablet, so if you swallow your oestrogen as a tablet, there’s a very slightly higher risk of having a blood clot. But it’s a very slightly higher risk than not very high at all, so it’s still a very small risk.
The question I get asked a lot about is breast cancer. There’s been so much misinformation over the years about HRT and breast cancer that actually it’s scandalous to be truthful.
HRT will not give you breast cancer. Women have a lifetime one in eight risk of developing breast cancer, but the risk changes with your age. It’s different when you’re 40 than it is when you’re 70, the risk is increasing all the time.
So there’s nothing to suggest that HRT gives you breast cancer, but if you have breast cancer there it may be that the tumour will grow more, in which case it’s detected more easily. Actually, what the evidence has shown is that women who develop breast cancer when they’re taking HRT have a better prognosis than women who have not taken HRT.
How long does it take HRT to work?
HRT can work very quickly. Certainly from the point of view of hot flushes and sweats, it can work within three or four days, so it’s very variable.
We normally say to people you need to give it three months to see whether you’re on the right dose or the right preparation, but generally results are quick.
For symptoms like anxiety and brain fog and more of the psychological symptoms, it’s probably going to take a bit longer. I often get emails from women within the first month or so saying “thank you so much, my life is transformed now”.
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How long do I stay on HRT for?
There was this figure of staying on HRT for five years, which was plucked out of the air really. There’s no evidence to support that.
We would normally recommend that women stay on HRT for at least seven years to give them the benefit for their bones and their brain and their heart. However, you can stay on HRT for as long as you like, and you can stay on it until the day you die. If you feel well and you don’t have any other conditions that mean that you can’t take it then there is no reason why you should stop it.
Also, we know that many women in their 60s are still having menopausal symptoms. If you tell them to stop taking HRT after five years they’re still going to be in the midst of all of their menopausal symptoms. So you’re not doing them a service at that point.
Does HRT delay the menopause?
Taking HRT doesn’t delay the menopause. Your own hormonal changes will carry on doing their own thing. But it will relieve your symptoms. If you were to stop HRT, at that point when you stop it your body will behave in the way that it would be behaving had you not taken HRT.
Again, remembering that many women still have symptoms in their 60s, if you stop it when you’re 58 and then have symptoms, women think that what they’ve done is just put their menopause on hold and then it’s starting again. This is not the case, you go back to where you would be had you not taken it.
You’ll find more videos from Dr Stephanie Goodwin on menopause and perimenopause on the Hylda YouTube channel. Who needs Netflix! Subscribe now and get the answers to all your midlife health needs. (Then you can go back to Netflix.)