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To HRT or not to HRT?

What a good question this is! In the 1990s, it was a common practice to give a woman oestrogen and progesterone in order to treat hot flashes and other symptoms of menopause. This was until a comprehensive study was released that indicated a risk for developing heart disease in women who took this kind of therapy.

The practice of giving hormone replacement therapy declined quite a bit after that, but it is still being used today in select cases where menopausal symptoms are severe, and the woman recognises the possible risk of taking the medication. Hormone therapy is a good choice for certain women, depending on their risk factors.

Hormone replacement therapy is also referred to as oestrogen replacement therapy or menopausal hormone therapy. It is the practice of giving oestrogen and progesterone for the relief of the most common symptoms of menopause and for some, to slow the progress of ageing.

By giving hormone replacement therapy, the doctor is trying to replace the hormones no longer made by the woman’s ovaries.

Oestrogen is important for the body. Besides being responsible for the menstrual cycle and uterine wall thickness, it has an effect on the strength of the bones, affects how the body makes use of calcium, and increases the amount of HDL (“good”) cholesterol in the body.

Progesterone also plays a role in the female reproductive system. It causes the uterine lining to mature and shed at the end of the menstrual cycle.

If a woman takes oestrogen alone without progesterone for the management of menopausal symptoms, the risk of endometrial cancer (cancer of the uterus) increases. Progesterone thins the lining of the uterus so that the cells don’t proliferate and cause cancerous cells to develop.

Types Of HRT

There are many ways to receive hormone replacement therapy. You need to talk to your doctor about what kind of therapy is best for you. Here are some choices:

 Oestrogen alone. If a woman has already had a hysterectomy, she has no chance of developing uterine cancer, so oestrogen can be given alone as a form of hormone replacement therapy. Oestrogen can be given in several ways, including a pill you take once daily, a patch you wear for a week at a time, a vaginal ring, a gel you put on your skin, and an oestrogen-containing spray. Oestrogen alone will control the symptoms of perimenopause and menopause but may increase the risk of developing breast cancer in women who have oestrogen-sensitive breast cancer.

 Oestrogen and progesterone therapy. This is often referred to as combination therapy. It involves giving both oestrogen and a synthetic progesterone, called progestin. The progestin does not do much to reduce the hot flashes alone but is designed for women who still have their uterus in order to prevent uterine cancer.

 Bioidentical hormone therapy. There are compounding pharmacies that make bioidentical hormones given alone or in combination for menopausal symptoms. Bioidentical hormones are the same as the hormones in the female body and must be given as a cream or gel applied to the skin where it is rapidly absorbed.

Risks Of HRT

As mentioned, there are risks to taking hormone replacement therapy, including increased risks for heart disease, breast cancer, and stroke. In fact, certain types of HRT have a higher risk than others, and the level of risk can vary from woman to woman depending on her health history and lifestyle.

It is important to discuss both the risks and benefits with your health provider. Typically, the best route is to take the lowest dose and re-evaluate the treatment every six months.

The biggest study on this issue was the Women’s Health Initiative, which was a 15-year study that looked at more than 160,000 women who were past menopause.

According to the study, women who took both oestrogen and progesterone had an increased chance of developing cardiovascular disease.

In the study, the risks of taking these medications over the long term outweighed any benefits taking the medication had on menopausal symptoms.

There are some women for whom hormone replacement therapy is never appropriate. Talk to your healthcare provider if you have any of these conditions and are considering taking hormone replacement therapy:

 A history of blood clots, such as deep vein thrombosis or pulmonary emboli

 A history of uterine, endometrial, or breast cancer

 A history of cardiovascular disease

 Problems with liver disease in the past or present

 A previous heart attack

 If you are possibly pregnant

 If you have had a stroke in the past

If you have any of these conditions, the risk of taking hormone replacement therapy may outweigh the benefits of taking the therapy, and there may be other medications that will be more beneficial.

Side Effects Of Hormone Replacement Therapy

There are side effects of taking hormone replacement therapy that may be significant enough to stop taking the medication or may not wish to start taking it. These include the following:

 Breast tenderness or swelling

 Bloating of the abdomen

 Changes in mood

 Nausea

 Headaches

 Vaginal bleeding

If you have any of these symptoms, talk to your doctor about whether or not hormone replacement therapy is right for you.

Weighing The Pros And Cons Of HRT

Read all you can about taking hormone replacement therapy and know your past and present medical history. Take this information to your doctor in order to decide if it is safe for you to take this type of therapy.

For some women, especially those with severe symptoms, it may be the only way to control the symptoms. If the symptoms are mild or there are other health issues to consider, hormone replacement may not be the best choice for you.

Never be pressured into taking HRT by your Doctor. My personal opinion is to try every other natural avenue possible to prevent using HRT. If using hormone replacement therapy at all, it should be bioidentical hormones that are compounded just for your individual needs and not a general product.

If you choose to take hormone replacement therapy, you should re-evaluate its need every six months or so with your doctor. I would recommend an integrative Doctor and also working with a health coach and naturopath. At some point, the hot flashes will be in control, and you may decide it isn’t worth the risk of taking this type of medication.

There are many pieces to the menopausal puzzle and your general wellness. When working with clients, I have found that we need to address EVERYTHING, not just a symptom! My approach is holistic, and that is the only way that guarantees a whole body and life transformation — balancing your Hormones, checking your thyroid, optimising your diet according to YOUR body type, using supplements that are also tailored just for you, finding movement that brings Joy to your body, detoxing your body and your environment. And last but not least, creating and shaping your next season in your life that makes you content and secure and excited! I am very excited that you have decided to read this book and that we are on the journey together. By the end of this book, it is my hope that you will feel confident in going through menopause. That you have a plan in place for your symptoms and your support systems but even more importantly, that you are looking forward to this super special time in your life!

I am not kidding! Gone are the times when menopause was the beginning of our end! We live so much longer these days, so consider that someone just gave you a brand-new annex to your house! All you need to do is figure out how to treat it best, how to furnish it and what it is that you are going to allow through the door! And best of all, we are going to do this together! There is a whole tribe of women out there going through the same as you, ready to kick the symptoms, the added weight and along with it, the stuff that drags us down!

It’s our time now! Time to create a happy, healthy, and meaningful fun life for yourself! Let's dive in!