Menopause Frequently Asked Questions
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Who should not take menopausal hormone therapy (HRT) for menopause? What are the common side effects?
HRT should not be used by women who:
• Think they are pregnant
• Have problems with vaginal bleeding
• Have had certain kinds of cancers (such as breast and uterine cancer)
• Have had a stroke or heart attack
• Have had blood clots
• Have liver disease
• Have heart disease
HRT can also cause these side effects:
• Vaginal bleeding
• Bloating
• Breast tenderness or swelling
• Headaches
• Mood changes
• Nausea
Be sure to see your doctor if you have any of these side effects while using HRT.
Do I need to undergo any tests before starting HRT?
HRT is not appropriate for all women.
If you decide to take HRT you should have a number of initial tests which may include:
• Breast examination
• Internal pelvic examination
• Blood pressure
• Test of thyroid function
• Measurement of weight and height in order to determine body mass index (BMI)
While you are taking HRT your blood pressure should be checked every six months and you should continue having regular cervical smears and breast screening.
Will HRT make me gain weight?
This is one of those questions that so many women ask. It's especially worrisome because it's very common to put on weight when you're first experiencing menopause.
As your estrogen levels drop, your body tries to keep as much estrogen as possible circulating. Since estrogen is both stored and produced in fat cells, your body may try to increase its fat content. To make matters worse, you also often tend to put weight on in your middle -- winding up with a disappearing waistline and tummy bulge.
The good news? HRT may actually help. This is what a number of studies have found -- women on HRT tended to gain less weight than those who weren't on it. In fact, when you raise your estrogen levels via HRT, you may actually notice a weight loss. You're getting the estrogen your body expected to have, so it doesn't need that extra fat any more. Plus your weight redistributes back to its normal pattern -- so your waistline reappears and your tummy may flatten a bit.
But some women do say they notice weight gain while on HRT. One culprit may be synthetic hormones, particularly the progestin "medroxyprogesterone acetate" or MPA (most common brand: Provera). This is because some women suffer side effects from this, including bloating and water retention. Natural progesterone doesn't seem to have this side effect. And other women have found that lower dosages of estrogen and progesterone helps keep bloating down. Finally, others report good luck with patches instead of pills
My doctor put me on birth control pills. Is there a difference between bcps and HRT?
This is another of those areas about early menopause that gets very confusing. Birth control pills are often prescribed to women in perimenopause -- that time when they're getting symptoms, but still are getting periods to regularize the periods and decrease bleeding. Bcps are synthetic hormones and have different dosage as compared to regular HRT.
I’m on HRT and I feel miserable. Now what?
Don’t give up! First, it sometimes takes a few weeks to notice a marked difference -- so it may make sense to wait a little while to see if the HRT helps you. Second, often switching forms of HRT -- from a synthetic to a natural, or from a pill to patch -- can make a difference. Our bodies are all different, so different forms of HRT may work better for you than others. Talk to your doctor, explain that you’re not satisfied and that you're interested in trying something new.
What is the risk of breast cancer with HRT?
• Women who do not take HRT
About 32 in every 1000 women aged 50 (who do not take HRT) will get breast cancer by the time they reach 65.
• Oestrogen only HRT
In women aged 50 who take oestrogen only HRT for five years, about 33.5 in every 1000 will get breast cancer. That is only an extra 1-2 cases. If they take it for ten years this could rise to 37 cases in a 1000. Results from the oestrogen only study form the Women’s Health Initiative released in early 2004 found that women who took oestrogen only HRT had no increased risk of breast cancer.
• Combined HRT started at age 50
The number of cases that would be diagnosed by 65 would be 38 cases in a 1000 after 5 years i.e. an extra 6 cases, and 51 in a 1000 after 10 years i.e. an extra 19 cases. Results from a recent Swedish study found that continuous combined ‘bleed-free’ products carried the highest risk.
• Tibolone
The risks of breast cancer have not been studied for this product but are thought to be between those for oestrogen only and combined HRT.
How significant are the other risks of HRT?
• Cancer of the Womb Lining
Taking oestrogen only HRT makes the womb lining thicken, and this increases the risk of cancer developing. This risk is reduced (but not totally eliminated) by taking progesterone which gets rid of any excess womb lining in the form of a withdrawal bleed. Any abnormal bleeding which begins after starting HRT needs to be investigated.
• Ovarian Cancer
Using oestrogen only HRT for more than 5 years may slightly increase the risk of getting this rare but serious cancer. It is not yet known what effect combined HRT has on ovarian cancer.
• Heart disease
The latest advice is that HRT does not protect against heart disease as was previously thought. Also products which contain conjugated oestrogen (oestrogen from the urine of pregnant mares) and a type of progestogen called medroxyprogesterone may increase the risk of heart disease in the first year of use.
• Stroke
HRT slightly increases the risk of having a stroke. For women in their 50s who do not take HRT about 3 in every 1000 will have a stroke in any 5 year period compared to about 4 in a 1000 women of the same age who take HRT for five years. Stroke risk goes up with age. For women in their sixties who do not take HRT, about 11 in a 1000 will have a stroke over a 5 year period compared to about 15 in a thousand women who use HRT for five years.
• Venous thromboembolism
Harmful clots can develop in the veins. If a clot develops in the deep veins of the legs it is called a Deep Vein Thrombosis (DVT). If a part of the clot breaks off and moves into the lungs it can cause a potential life threatening obstruction called a pulmonary embolism. The term venous thromboembolism (VTE) covers both deep vein thrombosis and pulmonary embolism.
Research shows that women who take HRT are more likely to develop a VTE than those who don’t, especially in the first year of using HRT: for women in their fifties who do not use HRT, about 3 in a 1000 will have a VTE over 5 years compared to 7 in a 1000 women of the same age who use HRT for 5 years.
• Dementia
Contrary to what was previously thought, research currently shows that HRT has no beneficial effect on mental functioning and may increase the risk of dementia later in life.
• Weighing up the risks
Despite the current safety recommendations, it is important to emphasise that the increase in risks identified by these studies is small (in a study done by the Imperial Cancer Research Fund, reported in the late 1990s, the risks linked to HRT rapidly reduced after stopping HRT and disappeared after five years). Each woman needs to discuss the pros and cons of HRT with their doctor to see if it is suitable for them. Some doctors may agree to prescribe HRT for longer for those women who feel that the benefits of HRT outweigh its risks.
Can menopausal hormone replacement therapy (HRT) prevent heart disease or Alzheimer’s disease?
Some research has shown that women who start estrogen or certain types of hormone therapy around the time of menopause are less likely to get heart disease. But a very large study by the U.S. National Institutes of Health (NIH) had different results. The NIH research found that:
• Estrogen alone didn’t affect the risk of a heart attack. Estrogen did increase the risk of stroke. Estrogen also increased the risk of blood clots in the legs.
• Estrogen plus progestin may have slightly increased the risk of a heart attack. Estrogen plus progestin raised the risk of stroke and blood clots in the legs and lungs.
Researchers continue to study this issue. The age at which HRT is started may be the key to whether this therapy reduces your chances of getting heart disease. Most of the women in the NIH study did not start HRT until after the age of 60. Yet menopause happens for most women after the age of 45. Some experts think that many of the women in the NIH study may have already developed narrowing and hardening of the arteries because of many years in which their estrogen levels were low. This would explain why estrogen did not protect against heart disease in the study.
More research on younger women may support the use of some kind of HRT to prevent heart disease. And more research will be needed to ensure that the benefits of such a therapy outweigh its risks. For now, the safest option for hormone replacement therapy is to stick with the lowest dose for the shortest time to treat menopausal symptoms or treat bone loss, but not to prevent heart disease.
Studies on the effects of HRT on memory and other brain functions also have had mixed results. For now, HRT should not be used to prevent memory loss, dementia or Alzheimer’s disease.
Continued » Menopause FAQ Page 4
If you have any queries regarding the topics raised within this article please do not hesistate to contact the Women's Health Clinic via the email form at the bottom of the page or by calling our London clinic on 020 8947 9877.
