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HRT Forever?

Should women take HRT before the menopause? Some experts now say it’s the best way to ease your symptoms – and avoid long-term health problems – but is this just another way of selling more drugs? Bioidentical doctors would certainly not recommend it but is it for you?


An article yesterday in the press was suggesting that women pre-menopause should be taking HRT as a ‘preventive’ action from 40 onwards. As far as I know, menopause is not preventable – like other natural transitions such as puberty – but help can be given with symptoms. My experience, and those of the many women I have been contacted by, is that HRT is definitely not the answer to a problem but the beginning of one.

What’s the problem?
The issue to me seems to be that uptake of HRT has fallen off as more women choose a natural solution with bioidentical hormones but their doctors have not caught up. According to a recent survey, ‘many menopausal women are struggling without HRT’ as apparently doctors only offer help when symptoms become unbearable and concerns about possible side-effects have led many GPs to recommend that women try to manage without hormone replacement therapy. Instead many women have found they are now being offered antidepressants to cope with their symptoms. In fact, nearly a quarter of women who’d seen their GP about their symptoms said the menopause was never discussed.

What is not stated is who carried out the survey and on whose behalf, but unfortunately they haven’t been offering another alternative or solution, but women have been seeking it out for themselves. Switching HRT brands is the usual option offered, but the side effects of the drug are not acceptable to many women, in fact they can be worse than the menopausal symptoms they are prescribed for.

But now some specialists are calling for a radically different approach; they say women shouldn’t just have to cope, but should be encouraged to take preventative action in their 40s, when early menopausal changes occur – or perimenopause as it is known. The aim is to help women avoid potentially distressing menopausal symptoms in their 50s, and also reduce their risk of conditions related to the menopause, such as osteoporosis and heart disease in older age. However heart disease and osteoporosis both require progesterone, not a synthetic progestin, and certainly oestrogen (the main component in HRT) has been linked to heart disease and strokes which is why doctors are increasingly reluctant to prescribe it.

If you and your doctor can’t agree about HRT then the view of Vice-chair of the Royal College of GPs, Dr Tim Ballard, might explain why. He speaks for many GP’s and says that HRT should only be given for a short period (up to two years), so women are likely to be advised to wait until symptoms are severe before they are prescribed it.

How to deal with perimenopause symptoms
The first problem is that many women don’t realise that their hormonal changes are already occurring – you may notice them from 40 onwards – and can be different from month to month. When hormone levels fall then you can get disturbed sleep, anxiety and depression as well as flushes and sweats, breast tenderness, foggy thinking and headaches.

Certainly helping hormone balance is critical at all points in a woman’s life – PMS and fibroids are good examples of problems that can occur – but the answer is not HRT and synthetic hormones. Identifying when you are in perimenopause is the first step and there are some simple solutions that can help.

Last Saturday, World Menopause Day, was marked by a call to see the perimenopause as a time of great medical opportunity, and not the uncomfortable and slightly embarrassing life stage which it’s so often regarded as. You note the call was for medical opportunities but what about the alternatives?

There are lifestyle and dietary changes that will make a difference, as will the use of bioidentical hormones which naturally replicate a woman’s own levels. In my view the best early start is to know your own body, follow the progress of your symptoms and be proactive in finding strategies that can help. There is no doubt that some women find HRT entirely helpful, but for the many who do not then here are simply tips that can help.

Reduce these:

* stimulants such as smoking, caffeine and alcohol
* refined carbohydrates
* red meat
* carbonated drinks
* high sugar food and drinks (including wine)
* weight as it is linked to oestrogen dominance

Increase these:

* fruit and vegetables
* whole grains
* omega 3 and 6 oils/foods
* nuts and seeds such as pumpkin, sunflower, almonds
* exercise more
* phytoestrogens such as soy
* tryptophan-rich foods for mood improvement such as cottage cheese, turkey, oats

Bioidentical hormones

There is no agreement amongst the experts on the long-term safety of different forms of HRT but bioidentical hormones are consistently recommended as safe for menopause symptoms. Studies suggest hormones taken orally (such as the Pill/HRT) can increase the risk of blood clots because they have to pass through the liver – which hormones delivered via creams do not.

Doctors Shirley Bond and Tony Coope have both been prescribing bio-identical hormones for many years and seen the benefits for women from puberty to post-menopause and they are in no doubt that they are preferable to HRT. This is not the established medical view however as a spokesperson from the Royal College of Obstetricians and Gynaecologists said: ‘Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.’

Well as a menopausal woman myself ‘usually’ is not good enough for me though they do recommend that a transdermal route of administration is best for hormones.