Managing Menopause: Is Hormone Replacement Therapy for you?

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Hormone Replacement Therapy (HRT), can offer relief to many menopausal women to alleviate symptoms that impact on their daily quality of life, but it isn’t for everyone. This may include those women already ‘oestrogen-dominant’. This final article in the series by Wendy Sweet on ‘Managing Menopause’, takes a look at HRT and explains why it may no longer be the panacea for symptom relief as advertised to women in the past.

As millions of women have known for centuries, the symptoms of peri-menopause (the years leading into menopause) are often the hardest to cope with. Hot flushes, night sweats, mood swings and lack of energy leave many menopausal women not only frustrated and humiliated, but also exhausted.

Although in the past this ‘change of life’ was viewed favourably as a return to a carefree lifestyle, for many women, the symptoms signal a turn to medication, classified as Hormone Replacement Therapy (HRT). Offering relief to women for decades, these days, a number of different medications are available to women transitioning into and through menopause. Choices abound, unlike days of old.

oestrogen dominance

The first commercially available hormone treatment was offered to women in the 1890s. A substance called Ovarin was made from desiccating and pulverising cow ovaries and it claimed to treat menopause symptoms. Over the next two decades other pharmaceutical companies came on board with various concoctions of ovarian extracts purported to relieve vasomotor symptoms (hot flushes).

In 1930, the biggest breakthrough came with the development of oestriol glucuronide which was isolated from horse urine. Other replacement therapies followed until in 1942, Premarin arrived on the United States market from Ayerst Laboratories.

Premarin use skyrocketed in the 1960s with new and highly glamorous advertising campaigns that turned menopause (like ageing), from a ‘natural transition’ into a highly medicalised ‘problem’ that must be ‘treated’ for the rest of a woman’s life. A typical excerpt from the 1960s advert for Premarin was in fact, marketed to men.

‘The physician who puts a woman on ‘Premarin’ when she is suffering from the menopause usually makes her pleasant to live with once again. It is no easy thing for a man to take the stings and barbs of business life, then to come home to the ‘turmoil’ of a woman going through the change of life. If she is not on Premarin, that is.”

Today, HRT refers to both plant-sourced (often marketed as ‘natural’ or bio-identical) or animal sourced (yes, still horse urine!) preparations which replace the common hormones that naturally decline during the transition through menopause. All are ‘synthetic’ although many women become confused with the marketing of plant sources of oestrogen which are called ‘bio-identical’ hormone therapies (BIHRT).

Some women benefit from HRT for symptom management, some don’t. This is especially so for women who might be ‘oestrogen dominant’ (refer side-bar).

Women also should understand that taking oral HRT is not ideal. Putting on a patch and having hormones absorbed through the skin (trans-dermal) offers better absorption and uptake of the hormones.

It’s a personal choice between a woman and her doctor about the decision to take HRT. Sometimes however, if doses aren’t regulated well, taking HRT may cause other issues. For example, in some women, poor gut health as well as a ‘fatty liver’ (steatosis) may inhibit the absorption and action of the hormones. The hormones might also wreak havoc on the liver, causing metabolic changes, which increase the presence of inflammation as well as the production of proteins which could contribute to blood clots. In blood screening, this may be seen as disordered liver function tests.

The other concern about HRT is how long women should take it for. The first inkling of the concern with long-term use of HRT (defined as five years or more), was recorded by the Women’s Health Initiative (WHI) Research study in the early 2000s.

This study involved 161,808 generally healthy post-menopausal women. The clinical trials were designed to test the effects of post-menopausal hormone therapy, diet modification, and calcium and Vitamin D supplements on heart disease, fractures, and breast and colorectal cancer.

The hormone trial had two studies: the oestrogen-plus-progestin study of women with a uterus and the oestrogen-alone study of women without a uterus. This study ceased because of the following findings:
–  Cardiovascular disease increased in long-term hormone replacement users
–  Breast and ovarian cancer risk increased in long-term hormone replacement users

The appropriate dose and duration of HRT is undecided in long-term use.

HRT may improve post-menopausal osteoporosis, but only in those women whom risk of osteoporosis is high e.g. smokers

Following the findings of the WHI studies, the Food and Drug Administration (FDA) in America now recommend that hormone therapy be used in short-term circumstances only (five years or less) and at the lowest dose possible to achieve treatment goals.

What about ‘phyto-oestrogens’ for symptom relief?
Phyto-oestrogens and isoflavones are substances found in plants and may act as weak oestrogens. Foods promoted for this purpose include yams, soybeans, soy products, lentils, bean sprouts, alfalfa and flaxseed (linseed).

These typically bind with oestrogen receptors in the body causing a weak oestrogen-like action. According to New Zealand’s Dr Beverley Lawton, long-term effects of taking phyto-oestrogens are unknown and they may have similar risks as HRT and will not stop post-menopausal bone fractures.

Evening Primrose Oil (EPO) is commonly promoted for menopause symptom relief. But gold standard trials have shown that it does not work.  For a more comprehensive insight into other treatments, Dr Lawton’s book, ‘A Woman’s Guide to Menopause’ is available.

Although it seems that HRT is losing favour in some circles, women transitioning through menopause can still obtain adequate symptom relief by reviewing their nutrition, exercise, stress levels and other aspects of their lifestyle. These lifestyle changes have been covered in previous articles in this series.

For more information on a range of issues about menopause, check out Wendy Sweet’s ‘My Menopause Transformation’ Face-book page.

Wendy Sweet (RGN/ M.SpLS/ PhD Student, Waikato University)
An award-winning fitness and wellness educator in New Zealand and Australia, Wendy brings her personal experience as well as her research interest in women’s mid-life ageing and lifestyle behaviour-change to the relatively unspoken topic of ‘menopause’. Coming in early 2016, is ‘My Menopause Transformation’ (MyMT™) – an evidenced 12-Step Program of Lifestyle Change, just for women transitioning into and through menopause.

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