There is currently a lot of chat about HRT – should you take it now until you die, or is it linked to cancer and heart disease.
Firstly, what is it?
HRT is a combination of oestrogen and progesterone. Traditionally the focus was almost always just on replacing oestrogen but now progesterone is also sometimes incorporated. The way it is administered can vary from gels, to patches to oral and now there is a spray. There is a lot of research suggesting topical application is best, but each woman is unique and just like birth control, every woman needs to find what works for her. That may be synthetic, it may be bio identical. It may be nothing at all. The key is knowing your options and also what you can do.
The History of HRT
In 2002 the Women’s Health Initiative study showed that women taking synthetic hormone like drugs had a higher rate of breast cancer, heart attacks and strokes than those taking a placebo. Prior to this HRT had been considered the elixir of youth and now people panicked and 50% came off their HRT straight away. However, it turns out that from a heart health perspective the study was deeply flawed with the type of person it was tested on and the dosage. It has been long established that there is a very small risk of oestrogen being linked to breast cancer – but in the same way as alcohol, obesity and smoking and the benefits generally far outweigh the risks. Now studies are going further and looking into progesterone also. Researchers in France started to look at how breast cancer risks varied with different types of hormone replacement and found that biodentical oestrogen and progesterone hormone replacement therapy has either none or, in a small number of cases, a significantly lower risk of breast cancer than the synthetic progestagens (source; French E3N cohort study done on 80,377 postmenopausal women with 12 year follow up). It’s important again to note though that everyone is individual, has different lifestyles and different genetics, so always refer to your GP/healthcare provider.
Bio Identical and Body Identical Hormones
It’s worth reading the Chelsea and Westminster hospital booklet on Body identical or Bio Identical Hormone Replacement Therapy written by staff working in the Menopause and PMS service at C&W hospital (link at bottom of article). Their take home messages include:
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Body identical and bio identical are the same in that they resemble hormones produced within the body (i.e. are not synthetic) and are derived from yams and soy. Body identical are made in labs and are batch made in specific regulated amounts. These can and will be prescribed by GPs and some are available on the NHS. Bio identical are bespoke amounts and are usually made up by a pharmacist. Bespoke amounts are not available on prescription from your GP
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Some of these ARE licensed in the UK and can even be prescribed by NHS doctors and are not just available from private clinics. These include: oestrodial available in licensed HRT (an oestrogen) & natural progesterone (as a capsule) which are available on the NHS. It does not include progesterone as a cream due to limited data, DHEA or testosterone.
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In some cases, such as progesterone cream, there may be a great benefit to some women. However, the limited data suggests there might be an increase risk of endometrial cancer and therefore it cannot be recommended as part of a licensed HRT
So what to do?
See your GP!
If you feel that you need extra help, you must discuss this with your GP and push back if you feel that they’re not helping. Generally research and GPs knowledge and understanding is growing all the time and now they do have access to a range of products. But you do need to know what is available to you. Dr Katie Armstrong, GP and founder of Clinic 51 recommends the approach below:
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Work in partnership, don’t march in and tell them what you want
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Worthwhile filling out an e consult first
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Fill in a green climacteric scale – download and fill in, take to appt. Provides brief measure of menopause
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Look at Dr Louise Newson’s 2 page on how to prescribe HRT
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Say “I would like to try x”
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Research your nearest NHS menopause centre (not gynacologist)
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If you’re still not happy a specialist such as Dr Katie from Clinic 51, or Dr Anu Arasu at Bio Identical Clinic in London both do zoom consultations
Also, hormones fluctuate so actually it’s quite difficult to see for sure if you’re e.g. low in oestrogen. GPs may check your FSH and LH levels, but even if these come back stating that there are no issues, this may not be the case. In terms of how long you can take HRT, there are apparently no NICE/NHS guidelines suggesting that you need to stop taking HRT after 5,10 years etc. It will not delay perimenopause/menopause – so wherever you are 5 years down the line will be exactly the same whether you take HRT or not. However, it is worth checking in and doing an in depth check up with your GP yearly to discuss if you do still need to take it.
BUT ALSO! Every woman is unique – different things will work for different women. But a lifestyle that includes movement, good nutrition (B6, Magnesium and Vit D can massively help how we feel at this life stage) and specifically finding some stress solutions can only make you feel better regardless of age and situation. HRT can help your bones and muscles, improve incontinence and anxiety. But doing strength exercises for your bones, brain, metabolism, (just about everything), cardio for your heart and your gut, going for a walk and breathing for your stress, eating fibre for your bowels, your heart, keeping your gut and your brain happy – these are all things you can control just by making choices about how to move your body and what to put into it. And every one of these feeds into your hormones which in turn will affect how you feel.
So, whilst taking HRT can and will help many women mentally and physically, taking it and making no lifestyle changes whatsoever is not an option. The whole reason I started looking into what is going on is to give myself options and information so that I can make informed decisions about what I do with my body. In our 20s and 30s we can get away with all sorts. However, when our hormones start to dip, from the age of 35, how we nourish and look after our bodies and brains is the biggest indicator of how we age. Our health in our midlife is the best predictor for our health when we get older (Ref Neuroscientist Lisa Misconi)
And again for me it’s adding joyful things in, not living a life of deprivation. So add in a break in the day, a tasty breakfast, a coffee, a walk outside, a chat with friends who make you laugh and an early night. Add sauerkraut on the side but add it to a salad you will enjoy. Enjoy a glass of champagne on a Wednesday and buy yourself some new pyjamas/bra! (Delete as applicable!)
Dr Anu Arasu’s booklet on Bio Identical Hormones Explained. https://www.amazon.co.uk/