Working with women’s hormones day in day out, I get asked a lot about HRT and in particular about the benefits and safety.
Now I am not a medical doctor, but it's my job to know a lot about hormones and treatment options. And make sense of the latest research so that I can educate and empower women to make informed choices.
Many people assume that just because I teach women how to manage their menopause naturally, that I’m anti-HRT. In actual fact, I'm a big fan of HRT (the right kind).
When I went through symptoms of peri-menopause in my early 40's I found that diet, lifestyle and supplements worked wonders for me. Fast forward to my early 50's and I started getting symptoms that I couldn't manage through my healthy lifestyle.
I had my hormones tested and both my oestrogen and progesterone were on the floor. With my mum having osteoporosis, there was no way I was going to put myself at extra risk.
So I did my research and chose to go onto body identical HRT in the form of Oestrogel and Utrogestan. This combination has eliminated my night sweats and more importantly is protecting my bones (and heart and brain!).
I actually think of natural body identical HRT as just another supplement that can help us to rebalance. Just like Vitamin D, which is actually a hormone too! And Thyroxine which is given to replace low thyroid hormones.
Whether you can or want to take HRT or not, the most important thing is that it's YOUR choice based on good information. Informed, personal choice is what every woman deserves.
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The importance of diet and lifestyle
Whether you choose HRT or not, a good diet and lifestyle is a non-negotiable if you want to stay healthy as you get older.
Making sure you're getting plenty of nutrients, relaxation and movement. Not only will this likely help with your menopause symptoms, but it's vital for your general health as you age. Taking some targeted supplements can also move the needle in your favour.
However, for many women diet and lifestyle changes are not enough to relieve symptoms and also protect against the risk of more chronic conditions that can be due to low hormone levels.
HRT can be a life saver if your sex hormone levels are too low. And vital if you have had an early menopause or a surgically induced menopause (partial or full hysterectomy or oophorectomy).
What are the benefits of hormone replacement?
The right type and dose of HRT can work really well to ease the symptoms of the menopause – hot flushes, fatigue, mood swings, joint pain, brain fog, anxiety, insomnia, vaginal dryness and more.
It can also reduce your risk of osteoporosis, heart disease and dementia often caused by low levels of sex hormones.
Why is there so much controversy about HRT?
The benefits of HRT had been promoted since the 1950s and it was standard practice for women to take it once they reached menopause. However, in 2002, a large study by the Women’s Health Initiative (WHI) in the US sent a shock wave when it revealed that HRT (those taking a mix of Premarin and Provera) increased a woman’s risk of heart disease, stroke and breast cancer.
Many women stopped taking it, and advice was given to those taking it to only take it for a short period of time. A study published in 2013 followed a sample of these women for 10 years, after which they estimated that 50,000 women in this age group may have died prematurely by avoiding oestrogen replacement.
These and subsequent studies were all done on conventional HRT which comprised of ‘synthetic’ hormones. These synthetic hormones act in a similar way to your own hormones but are molecularly different.
Thankfully, we've moved away from the days of being given oestrogen from pregnant horse urine (yes seriously!), but we are still commonly prescribed synthetic hormones in the form of oral oestrogens. and progestogens (not progesterone) that are taken orally or in a combined patch.
These synthetic hormones are the ones associated with increased health risks and side effects. However even these forms of HRT are not as risky as the media would have you believe. Your risk of breast cancer for example is much higher if you're obese or drink too much alcohol.
Fortunately nowadays there are modern forms of HRT that are much safer.
What you need to know about HRT
There are 2 main things I want women to be aware of when choosing to take HRT;
1/ HRT is not a miracle cure if other hormones are out of balance!
Menopause is not just about oestrogen and progesterone. These are 2 hormones that can cause symptoms, but we have a hundred or so other hormones that can also suffer during this time.
HRT will only help with 2 of your hormones! And if the others are out of balance, you’ll need to sort those out (contact us for help with that).
2/ Not all HRT is created equal
The links between HRT and increased risk of breast cancer have ONLY shown so far to apply to combined synthetic oestrogen/progestin, taken orally. There is no evidence that I’m aware of that shows any additional risks if you take body identical oestrogen and progesterone.
What are Body or Bio Identical Hormones?
Fortunately more and more doctors are switching to ‘body-identical’ hormone replacement. The terms body identical and bio identical are one and the same thing.
Body Identical; NHS doctors know them as ‘body identical’ so that’s what you need to ask for if that’s what you want. The hormones used are still made in the lab, but are chemically identical to yoru own hormones. They are obtained primarily from plants (soya beans and wild yam) and pharmaceutically transformed into human body identical hormones.
Bio identical; private doctors and clinics prescribe bio identical hormones. They have been criticized by some medical professionals as unsafe and unproven as the compounding pharmacies that produce them are not widely regulated. However they have become popular as many GP’s are still reluctant to prescribe body identical HRT, they include testosterone and DHEA (not available currently on the NHS) and they are made to order for your exact dose by the compounding pharmacy.
Are body identical hormones safer?
Naturally occurring body identical hormones are not thought to carry the same risks as synthetic hormones, as the body treats them in a similar way to your own hormones.
Oestrogen is usually given transdermally (as a patch, gel or spray), absorbed directly through your skin into your bloodstream. This means that it bypasses your liver and causes less side effects. In addition, your liver produces clotting factors, which means that if a tablet of oestrogen is taken, there is a small increased risk of a blood clot occurring. This risk of clot is not present however, in women who take oestrogen through the skin as a patch, gel or spray.
Which Body identical HRT brands are available on the NHS?
Body Identical oestrogen available is in a patch, gel or spray form, as well as vaginal pessaries and creams;
- Gel; Oestrogel, Sandrena
- Patch; Estradot, Evorel, Elleste Solo, Estraderm, FemSeven Mono, Progynova
- Spray; Lenzetto
Local Oestrogen applied in the vagina can also be very helpful for vaginal dryness, itching, redness, bladder issues. They are low dose so can be taken safely by most women. These include;
- Vagifem (oestradiol pessary), Imvaggis (oestriol pessary), Ovestin (oestriol cream), Blissel (Oestriol gel), Estring (ring)
Body Identical progesterone (micronized) is available as an oral capsule;
- Utrogestan 100mg Capsules
As of the time of writing this, testosterone is only currently available through private doctors.
Is HRT right for you?
Every woman is different. I know women who thrive on HRT, while many who don’t want to or can’t take hormones, or are worried about HRT safety, have managed to deal with their symptoms without any prescriptions at all.
The most important thing is that you take responsibility for your own health and make sure you’re fully informed:
- HRT has many benefits, including reducing risks of osteoporosis, heart disease and dementia
- HRT is just sex hormone replacement. Diet & Lifestyle are still your foundations for all your other hormones
- Modern body identical HRT is safe and effective
- Do your own research and be fully informed to make the choice that's right for you
- Get tested privately if you can afford it – while blood tests aren't that helpful, comprehensive urine tests can show your hormone levels, how efficiently you are metabolising and detoxifying your hormones and whether there are any other health risks or genetic factors that could affect your treatment.
A woman’s life expectancy in the 21st century in the western world is now over 80 (according to the World Health Organization). The average age of menopause is 51. That means that we will be living potentially for 30 years in post-menopause so it’s important to make sure those years are the best they can be!
If you're not feeling 100% whether you're on HRT or not, do contact us – we can help identify which hormones may be out of balance through our testing and 1-1 support.
If you’d like to do some more research or take information to your own doctor, Dr Louise Newson’s website has some great resources.
(The information presented in this blog is for informational purposes only and is not intended as a substitute for advice from your physician or doctor or other health care professional.)