Menopausal hormonal therapy (MHT), formerly known as hormone replacement therapy (HRT), has long been considered a safe way for healthy women to manage menopausal symptoms such as hot flushes and vaginal dryness. Around 12 million women worldwide use MHT.
The fluctuation of hormones during menopause can sometimes cause symptoms such as mood changes, sleep problems and night sweats. MHT helps to restore hormone levels, which may improve some of these unpleasant symptoms.
The main hormone used in MHT is oestrogen. In women who have not had a hysterectomy, progesterone needs to be taken at the same time to reduce the risk of endometrial cancer. Medication tends to be split into combined MHT (taking both hormones) and oestrogen-only MHT.
Some women also benefit from a low-dose testosterone replacement to improve low libido, lack of energy and fatigue. There are various ways to take MHT, including tablets, skin patches, gels and implants.
Dr Paula Briggs, a consultant in sexual and reproductive health stresses women should be given the right information to make an informed decision about how they manage their menopause, and it doesn’t have to be with MHT.
She explains: “MHT replaces the hormone women’s ovaries are no longer producing regularly or reliably, so it tends to be the most effective way of managing the menopause transition. But there are other ways of doing that – whether that’s with lifestyle changes or using prescribed alternatives, some of which are antidepressants. It depends on the woman’s background, and medical and family history.”
So, what are the risks and benefits of MHT?
Benefits of MHT
“The main benefits of MHT are symptom control,” says Dr Briggs. “It’s the best way of controlling common menopausal symptoms such as hot flushes, night sweats and difficulty sleeping. If you don’t sleep, your ability to function becomes impaired, you feel anxious and it’s difficult to do your job.”
“Longer-term treatment maintains bone mineral density, too. Osteoporitic fractures are a major cause of morbidity and ill health, so anything that reduces that risk is good – but it’s got to be in the right dose, and in the right patient,” says Dr Briggs.
Dr Louise Newson, founder of The Menopause Charity (themenopausecharity.org), believes: “Taking MHT vastly improves your symptoms, and helps protect against long-term health risks or hormone deficiency. Even low levels of MHT can have benefits in your body and improve symptoms of menopause. Many women describe this as giving them their lives back.”
Dr Briggs mentions the suggestions that MHT can prevent Alzheimer’s disease, but stresses: “It’s not based on any robust evidence, and we have to be very careful about the messages we’re giving to women, so their expectations of the treatment are realistic.”
Risks of MHT
The main risk is that some types of MHT lead to a slightly increased risk of developing breast cancer or thrombosis (blood clots in the legs or lungs). However, it can prevent other conditions such as osteoporosis, heart disease, fractures, diabetes and some types of cancers.
The risk really depends on the type you take, how long you take it for and if you have any existing health conditions. Some studies have found there’s little or no change in the risk of breast cancer if you take oestrogen-only MHT, and combined MHT can be associated with a small increase in the risk of breast cancer, related to how long you take the medication for. This risk falls after you stop taking it.
Experts stress because of this increased risk, it’s especially important to attend all breast cancer screening appointments.
Current international recommendations say that the benefits outweigh the risks in women who are having significant symptoms from menopause, and that MHT is effective and safe for most healthy women.
MHT doesn’t significantly raise the risk of cardiovascular disease (including heart disease and strokes), and when it’s started before the age of 60 it may, in fact, reduce the danger.
“The main things are cancer and cardiovascular risk,” says Dr Briggs. “But for otherwise healthy women who are below the age of 60, the benefits outweigh the risks.”
Some women have side-effects such as nausea, fluid retention, bloating, breast tenderness and swelling, and irregular bleeding. These often go away with time.
According to Health Direct, MHT may not be suitable for you if you have or have had:
- breast cancer, endometrial cancer or other cancers that are dependent on hormones
- undiagnosed vaginal bleeding
- untreated uterine lining thickening
- raised risk of thrombosis
- coronary heart disease, stroke or dementia
- blood clots in the legs or lungs
- untreated high blood pressure.
The risks of MHT depend on your age, the type and dose of hormone therapy you take, duration of treatment, and your medical history.
Talk to your doctor to find out which risks apply to you. If you are unable to take MHT, your doctor may suggest other medications that may be helpful.
– With PA
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