Hormone Replacement Therapy (HRT) was first used for the treatment of Menopause symptoms in the 1960s. It became widely available in the UK around 1965 and continued to grow in popularity through to the 1990s. People saw the medication as life changing, so what changed?
The biggest concern for most individuals is the increased risk of Breast Cancer. In 1992 a study run by Women's’ Health Initiative, (WHI) began following a large number of women taking HRT to assess benefits, risks, etc. The study was due to run until 2007 but in 2002 the study was halted prematurely due to a perceived increase in rates of breast cancer among those using HRT.
Since then, the WHI study has been widely criticised and proven flaws with the study identified by many experts in the Menopause field for a number of reasons, for example the average age of the individuals in the study was 63 years so many of the women were a long time post-menopausal and the risk of breast cancer increases with age without external causes.
In truth the increased risk of breast cancer with HRT use is only small. To look at the risk in context it is useful to look at the risk of other causes for women aged 50-59 years:
- Overall risk of breast cancer: 23 out of 1,000 women will develop breast cancer
- Add in HRT the number increases by an extra 4 women using combined Oestrogen and Progesterone. (4 LESS on Oestrogen, alone.)
- If women consume 2 or more units of alcohol per day there will be an additional 5 cases of breast cancer on top of the original 23.
- An additional 25 cases in overweight or obese women where BMI is 30 or more.
Alongside these risks add in smoking and we all know how high the risk is for all-cause health issues including breast cancer.
To lower the risk of breast cancer as we get older: ensure a good diet which includes plenty of fruit and vegetables, fibre, vitamins and minerals; increase exercise, both strength and cardiovascular; minimise the amount of alcohol you drink each week; maintain a healthy weight, and if you smoke...STOP!
Another concern many individuals have regarding HRT is whether it merely delays the Menopause and symptoms, as a result, when they stop taking the medication the symptoms will come rushing back so is it better to just "put up with it" now rather than wait a few years?
In fact HRT assists an individual through the journey, easing symptoms and making it easier to cope with. If an individual wishes to stop their medication and symptoms reappear as the dose is reduced it means their journey has not ended and may need the medication a little longer, so restart it and try stopping again at a later date.
Following on from the above concern is the time limit for using HRT. How long should an individual take the medication for? How old is "too old" for HRT? How long is "too long" on HRT?
Guidance from the National Institute for Clinical Excellence, (NICE) and those produced by British Menopause Society, (BMS) state there is no time limit to the use of HRT. An individual can take it for as long as they need to and is entirely dependent on the symptom control of the individual.
These are just a few examples of common worries and myths around HRT and individuals may have other concerns not addressed here. It is important for every individual to discuss all their concerns. If anyone would like further advice they can book time with a Menopause Nurse at myTamarin for a confidential, one to one chat.