Take Charge of Your Menopause Journey

Menopause is part of every woman's life, but many suffer through it due to fear of seemingly high risks associated with hormone replacement therapy (HRT). We now know that there was a lot of media misrepresentation and misinterpretation of data about the risks of HRT.

During both peri- and menopause, a range of symptoms can occur, the severity of which varies. These include night sweats, mood changes, fatigue and insomnia, poor concentration and brain fog, low libido, joint pain, vaginal and urinary symptoms, as well as hair and skin changes. These symptoms arise due to a decline in oestrogen, progesterone and testosterone. The most effective way to treat this is to replace and supply your body with these hormones.

What Are the Risks of HRT?

The risk, albeit small, depends on the type of HRT, the duration used, and individual genetic and lifestyle factors.

Although there is a small increased risk of developing breast cancer, using HRT for five years contributes less than one additional case of breast cancer per 1000 women. This is a significantly lower risk than drinking three glasses of alcohol per week. There is also a slightly increased risk of blood clots or liver disease if taking oestrogen in tablet form, however, using HRT through the skin as a gel or patch does not have these risks.

What Are the Benefits of HRT?

Advancements in HRT formulations have made it much safer. Using HRT will improve your symptoms possibly to the extent of feeling normal again and the impact on your quality of life can be significant. Oestrogen protects bone health from developing osteoporosis, the heart against cardiovascular disease and the brain from vascular dementia. Your risk of developing other metabolic diseases like type two diabetes can also reduce.

Oestrogen is important for many aspects of our health and the limited risks can be discussed with your doctor to decide on its long-term use, especially if mammograms and regular health checks are done.

Advancements in medicine and research have resulted in NICE (The National Institute for Care Excellence in the UK) creating menopause guidelines and recommendations that are continuously updated based on the latest evidence. Some noteworthy points include: www.pearlsmed.co.za

1. Blood tests should not routinely be used to diagnose menopause. It is diagnosed on symptoms and history.

2. HRT should be offered as first-line therapy for vasomotor symptoms and for low mood.

3. Antidepressants should thus NOT be routinely offered.

4. Vaginal oestrogen is extremely safe and should be offered for all women with urogenital symptoms.

5. Women should be supported in their decision on when to stop HRT. Based on an individualised risk/benefit discussion with your care provider, it can be reasonable to continue HRT lifelong.

My hope for all women is access to good care that is evidence-based and that resources can be used to open the door of communication and collaboration with your healthcare provider.

RACHEL is a biochemist and general practitioner at PearlsMed, Umhlanga. Her focus is on diabetes, women’s health and pediatrics.