Menopause has become quite the buzz word over the last few months. And for good reason – the symptoms of menopause can be extremely debilitating and life changing for some. The treatment we use for menopause symptoms – hormone replacement therapy can offer huge relief and over the alst few months it has been fantastic, certainly in my own practice, to see the evolution of HRT into something that can be considered necessary care.
The menopause is usually preceeded by the perimenopause. Symptoms of the perimenopause can precede the final menstrual bleed by years so it ias improtant to understand that you can have menopausal symptoms when you are still bleeding. Treatment of the symptoms with HRT is entirely up to the patient.
The average duration of symptoms is 7 years but 30 % of women can have longer episodes of symptoms. A health care professional cant outrule menopause just becsause a woman still has periods. Often during the perimenopause we have to juggle contraception needs along with hormone replacement therapy. The use of HRT is almost never contraindicated and it is important to have a detailed discussion with your healthcare professional to find out which treatment options would work best for you.
Symptoms of perimenopause are vast and can include night sweats and hot flushes, changes in menstrual bleeding, decrease in metabolism and weight gain, vaginal dryness and pain, hair and skin changes, joint pains and mood changes.
HRT is cardioprotective meaning that it has a protective effect on the cardiovascular system when started within 10 years of the last period. It does not follow that women > 10 years since LMP are at risk if they start HRT but more benefit is derived from commencing with 10 years of the LMP. Women with existing cardiovascular disease should be assessed by a cardiologist prior to commencing HRT.
HRT also has a protective effect on bone mineral density .
When I prescribe HRT I get asked frequently about the risks of HRT and breast cancer.
HRT is not a carcinogen. There is no direct evidence that HRT transforms benign breast cells into high risk pre malignant conditions. It is still poorly understood if hormones have a stimulatory effect on pre-existent quiescent pre malignant conditions. It takes about 10 years from breast cells to change from the pre malignant state to being a clinically detectable cancer. Malignant change cannot be reversed by stopping hormones.
HRT can be initiated by your healthcare professional and if your current lifestyle is significantly affected by any of the symptoms above – it may be worth a discussion.