We have seen increasingly dramatic headlines over the years about menopause and the risks of menopausal hormone therapy (MHT), also known as hormone replacement therapy ( HRT).
An alarming study in 2002, which found an apparent increased risk of breast cancer in women who took MHT, prompted the first of these headlines.
But newer evidence has been reassuring. It’s also a reminder that when considering your options, any risk associated with taking MHT needs to be balanced with the benefits.
This balance is the main thing your GP will consider when discussing whether MHT is right for you.
In 2002, the Women’s Health Initiative study found women who took MHT had a 26% increased risk of breast cancer. This finding, which was later disputed, led to a 55% drop in MHT use in the next three years.
A reanalysis of the data showed a lower risk of breast cancer in some women.
And in 2016, a statement from the world’s leading menopause specialists said the benefits of MHT are more likely to outweigh the risks if women with symptoms start taking it before they turn 60 or within ten years after menopause.
Then a study published in The Lancet in recent months suggested the risks might be greater than once thought.
However, this study combined the results of previous ones, including observational studies, which have limitations. Observational studies show associations between one factor and another, rather than one causes the other. So factors other than MHT might be at play in increasing a woman’s risk of breast cancer. As a result, these studies tend to overestimate the risks.
Other risks linked with MHT include thromboembolism (a type of blood clot). And in older women, there’s an increased risk of stroke.
What type of symptoms are we talking about?
Most women experience menopause (the date of her last period) at around 45-55 years of age. Some women’s periods stop before then, either spontaneously or due to some medical treatment, with varying symptoms and health risks.
However, menopausal symptoms may start before periods stop, and last on average seven to ten years. For a minority of women, symptoms can last for longer.
Physical symptoms include hot flushes, night sweats and vaginal dryness, with severe symptoms profoundly reducing women’s quality of life.
What are the benefits of Menopause Hormone Treatment?
MHT is available in different forms such as a tablet, skin patch, gel, and vaginal pessary or cream. These have advantages and disadvantages.
For example, some act on the whole body such as tablets, gels, and patches while others such as vaginal creams and pessaries act on the local area only. Those that act locally have no increased risk of breast cancer or thromboembolism.
MHT is an effective treatment for hot flushes, night sweats and vaginal dryness. Other treatments, such as bioidentical or natural hormones, have safety concerns. Others, such as phytoestrogens and many other herbal preparations, don’t work.
MHT also helps prevent osteoporosis, and may help prevent colon cancer, type 2 diabetes and coronary heart disease.
So how best to act on this?
The decision about whether to use MHT, which form, or to consider an alternative to MHT to manage your symptoms can be a complex one.
So, it’s important to form a partnership with your doctor who can guide you to make an informed decision. You may need several discussions over a period of time to fully consider what is right for you.