All you need to know about HRT.
As part of our Lunch & Learn series of webinars, Kathy Abernethy, former Chair of The British Menopause Society and Director of Menopause Services for Peppy Health joined us to answer your HRT questions.
Henpicked: Can you give us a recap on HRT – what’s available and the benefits and myths?
Kathy Abernethy: HRT is replacing the hormones our own bodies are no longer making as we approach the menopause or perimenopause. Menopause is when our last period was 12 months ago.
The months or years around this is when you can get symptoms and if you’re going to take HRT this is usually the time. The three hormones that make up HRT are oestrogen, progesterone and, for some women, testosterone. All HRT has oestrogen. If you’ve still got your womb then you’ll have progesterone. And if you’ve had a surgical menopause, if you’re young or have particular issues around sex drive you might be offered testosterone as well.
Henpicked: The risk and benefits equation is really important isn’t it?
Kathy Abernethy: Yes, you can read all the stats you like but the bottom line is: what’s your risk for HRT and what benefits are you going to notice? This is why, as an individual, you have to make your choice, looking at your health, medical history, family history etc. The benefits are good symptom control, reduced osteoporosis risk and improved cardiovascular system. Side effects could be bleeding or breast tenderness. It’s important to note that the risk of breast cancer for most women is very low indeed.
Henpicked: The long-term benefits are often the ones you don’t hear about aren’t they, such as cardiovascular benefits?
Kathy Abernethy: This is mainly a benefit for those who start HRT young or at least within ten years of menopause. But when I say young, you could be 60 or 65. But you still need to exercise, eat healthily and not smoke – HRT isn’t a replacement for these things.
Henpicked: Is it true that the first HRT preparation you try might not be the right one?
Kathy Abernethy: Yes, for those of us that prescribe HRT, we take into account your symptoms, your age and medical history, and try to put everything together. But we don’t always get it right first time. Individual women respond differently, so you might need to be prepared to try a different type.
There are lots of preparations available. The latest type is a spray, which works like a gel or a patch, through the skin. This has a lesser risk of thrombosis. If you have a risk, you want to minimise this and could use it instead of tablets. There are different doses and different brands of HRT. It’s unusual that we can’t find one that suits you.
Henpicked: How do you identify if the one you’re on isn’t the best for you?
Kathy Abernethy: The right one for you is the one that makes you feel normal. It won’t turn you into superwoman. You shouldn’t get side effects that you can’t tolerate, and any bleed should be that which is expected for the type of HRT you’re on. If bleeding is not when you’ve been told to expect it then it should be explored further. If you’re on continuous HRT – beyond the first three or four months, when you can be a bit unsettled – you should have no bleeding.
Henpicked: Is HRT the same dose the same throughout menopause?
Kathy Abernethy: As you get older you need lower doses but I’m talking about ten or more years after menopause. Or if you start HRT early, you might need to increase your dose for a while. Some women choose to stay on it, other stop. Be open minded. It’s never too late to go onto HRT from a bone protection or symptom point of view.
Henpicked: Can you remind us about diagnosis?
Kathy Abernethy: If you’re over 45 this is based on pragmatic discussion so you don’t need a blood test. Symptoms and period patterns can be enough. You might not have classic symptoms and your periods might not have stopped but at this point it’s likely you’re in perimenopause.
Henpicked: Can contraceptives mask symptoms?
Kathy Abernethy: If you’re using a combined pill or three weeks on and one off, menopause symptoms may well be masked. You may get breakthrough symptoms in your week ‘off’. If you’re on any other contraception, menopause symptoms won’t be masked but periods might be.
Henpicked: Do you need contraception if you’re taking HRT?
Kathy Abernethy: If you’re still seeing periods yes, until you’re about 55. If your periods have stopped and you’re under 50 and had two years without a period, or over 50 and have had a whole year without periods, you don’t need it. But remember, HRT is not a contraception!
Henpicked: We often get questions around low mood. Is this a common symptom?
Kathy Abernethy: Low mood is a symptom, you might feel very volatile or tearful. HRT usually helps, but if you’re sensitive to progesterone low mood can be a side effect. It might be worth changing to a patch, so you get a lower dose.
Henpicked: How about things like sweating and chills, which are other symptoms women have mentioned?
Kathy Abernethy: If you check your dose of HRT is correct, it could be this is a side effect of different medical condition. But you could try cognitive behavioural therapy (CBT), especially if this is happening at the same time every day.
Henpicked: What can you suggest for libido and vaginal dryness?
Kathy Abernethy: They really are interlinked. If you have vaginal dryness and sex is sore you’ll start to feel put off. This then becomes a cycle. Treating dryness is the first step. Then look around the whole issue of what makes you feel sensual as a woman. At this point, we have so many other things in life, as women we can lose that feeling of sensuality. If you’ve had a surgical menopause, you could consider testosterone. And remember, it’s absolutely normal to use lubrication, this can help with arousal.
You can also try vaginal oestrogen, which isn’t an HRT. It’s an easy treatment to use, and works as long as you take it. This can also help with urge incontinence.
Henpicked: Can you give us a quick recap on getting help and support from your GP?
Kathy Abernethy: Be absolutely prepared. Your appointment will be by telephone in lockdown, which actually makes it easier. Know you’re asking for – information, diagnosis or treatment. Do your homework, read up on HRT so your GP knows you’re informed, and ask them to point you to information if you can’t find it. You need to be clear on what you want to get.
Watch the video here:
Kathy has extensive clinical expertise as a menopause specialist, regularly seeing and advising women on all issues relating to menopausal health. An independent prescriber with a Masters in Community Gynaecology and Reproductive Healthcare, Kathy is immediate past Chair of the British Menopause Society, the professional society for healthcare practitioners.
Kathy’s excellent book is available through Amazon and good bookshops: The One-Stop Guide to Menopause.
She’s also the director of ‘The menopause course’ an educational initiative for nurses, designing and running study days, courses and events relating to menopause, and director of menopause services at www.peppy.health.