Menopause: should I take HRT?

By Dr Tashiya Mirando

What are the stages of a natural menopause?

Firstly, the pre-menopause is the time before any meno pausal symptoms occur at all. Next, perimenopause, is when you start to experience menopausal symptoms due to hormone changes and still have your period, though it might start to become heavier or irregular. Menopause, is when you do not have a period for 12 months consecutively; and finally, post-menopause, is the time after your menopause.

Perimenopause to menopause can take anywhere between 5-15 years, with most women experiencing it between 45-55 according to the World Health Organisation, and the average age being 51.

What do I need to look out for?

Remember, symptoms can vary widely in type, severity, and duration so each woman’s experience can be different. Effects can be seen within the menstrual cycle, joints, bladder and vagina, brain, skin, and organs.

• Period changes are often the first sign

• Hot flashes are very common

• Night sweats

• Sleep problems, often resulting in feeling tried during the day

• Mood changes

• Brain fog

• Joint pains

• Loss of sexual desire and vaginal dryness

• Thinning of hair and dry skin

• Weight gain (in all the difficult places!)

What can I do about it?

The first step should be taking to a healthcare professional! There are various ways to manage these symptoms to improve your quality of life. Starting with lifestyle measures, which I believe is an important step, and includes optimising your nutrition, sleep, and exercise, reducing stress, stopping smoking and cutting back on alcohol.

Hormone Replacement Therapy (HRT): Is it right for me?

Good question! The benefits of HRT can range from managing symptoms, to improving bone health and reducing the risk of heart disease, diabetes, bowel cancer, depression, and dementia, especially when started under the age of 50-60. For most women, these benefits outweigh any risks, which are very small and would depend on the type of HRT you take and your own medical history. I would highly recommend speaking to a healthcare professional early, so they can help guide your decision making in a way that is tailored to you.

What types of HRT are available?

There are various types and forms of HRT, including oestrogen only, combined oestrogen and progesterone, and not forgetting testosterone. These come in the form of tablets, gels, patches (not yet available in Singapore), and the hormonal intrauterine coil (used as the progesterone component, especially in women with heavy periods).

Okay, so what next?

• Speak to your family doctor early, especially if you are having symptoms and considering starting HRT or an alternative treatment.

• In the perimenopause, it is still possible to get pregnant whilst on HRT, so discuss this with your doctor and keep up with regular visits including health screening.

• Finally, have an open conversation with family, friends, and colleagues – you are not alone!

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