Dr Michelle Olver is an accredited menopause specialist and trainer for the BMS and the Faculty of Sexual and Reproductive Healthcare (FSRH). She plays an active role in education in both undergraduate, postgraduate, primary and secondary care settings and has worked with the FSRH to devise the new educational products offered by them to teach health care professionals about the menopause. More than half the world's population will experience menopause in their lifetime. So the number of misconceptions which still surround the topic is disappointing at best.
On average, women will hit menopause at the age of 51, while perimenopause can start as early as the late 30s. More than 75% of women will get symptoms, according to the National Library of Medicine. Hot flushes, brittle bones, anxiety, depression, brain fog, low libido, UTIs, insomnia, joint pain and heavy vaginal bleeding are just a few debilitating side effects that women can experience.
Hormone Replacement Therapy (HRT) is a group of treatments used to combat the physical and mental effects of the menopause. For many, HRT is a lifeline as they struggle to go about their normal lives without it. However, others recoil in horror at the thought of taking it - even menopause sufferers who are very unwell.
Can I take HRT if I'm at risk of breast cancer?
The three leading causes of death in women now are stroke, heart disease and dementia and HRT can potentially help with two out of three of those things. Lots of people automatically think breast cancer is the leading cause of death in women and then they decide they don't want to take HRT.
I have breast cancer referrals all the time which say: 'this lady can’t have HRT'. It’s all about helping them understand what we know about the risks, talking to them and then signposting them to evidence so they can make a decision for themselves.
We have women who could have [complications] associated with HRT but they accept the risk. I wouldn’t tell somebody not to do a bungee jump because there’s a chance they’d die. It’s up to them to make that decision on whether that risk is worth it for them, for quality of life, and we support women through those decisions.
Although some women would be willing to take that small risk to ensure they had a better quality of life, other women with the same small risk might not want to take the chance. It should be up to the individual with the support of education.
What are the health risks associated with menopause if I don't take HRT?
As previously stated, heart disease is one of the top three killers of women, along with strokes and dementia. Although the 2002 study suggested that HRT increased a woman's chance of having a heart attack, recent studies challenge this theory and suggest - particularly with modern types of HRT - the opposite is true.
Is there anyone who can't take HRT?
There isn’t anyone I wouldn’t give HRT to if they were aware of all the risks. The biggest thing I can think of is breast cancer, especially women who have oestrogen sensitivity cancers. But even the NICE guidelines say women who are having really severe symptoms and are having a really poor quality of life and have breast cancer, we can trial them with HRT as long as they are informed.
Are there any alternatives?
There are other options, you don’t have to give patients HRT. There are non-hormonal and non-invasive options. Cognitive behavioural therapy (CBT) is one which we have in house (at the clinic) and there are other medications which will help with their symptoms. HRT might not be my first line choice for someone, but if a woman says she’s tried these methods and wants to go on HRT then I would support them. We have breast cancer patients on our books who take HRT.
What HRT clinical studies are happening right now?
The study I’m most interested in is called the UK HRT trial. It's basically giving HRT to breast cancer sufferers. It's based in London and it's in active follow-up now. The results will be massive. All the studies done on breast cancer patients have been done with synthetic HRT whereas this will be using the body identical stuff. The other study which is currently recruiting is for young women who go through the menopause. There is also research looking for other non-hormonal treatments for breast cancer sufferers.
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