Hormone Replacement Therapy (HRT, or HT) is a way to help balance the key hormones that fluctuate during menopause - estrogen, progesterone, and testosterone. These hormonal changes are what cause many of the uncomfortable symptoms of both perimenopause (which can start up to 10 years prior to menopause) and menopause. These symptoms not only include hot flushes, weight gain and 'brain fog', but can also include lower sex drive, general fatigue, mood swings, irritability, and an increased risk of depression.
Due to a flawed study released by the Women's Health Initiative, and the subsequent media hype, many women were advised by their doctors not to take HRT for many years. However, the flaws in this study have now come to light. What's more, the hormones used today are more bio-identical to those we naturally produce in the body, and therefore safer. Today most experts agree that taking HRT carries a low risk for most women (except those with a history of breast cancer or clots), and may also have benefits such as improved bone and cardiovascular health and lower risk of some cancers.
Unfortunately, many doctors are either not aware of the latest research or are not incorporating it when it comes to advising their patients on a range of issues. For example, the first line of treatment for women experiencing depression in perimenopause and menopause is often an anti-depressant rather than HRT.
The main components of HRT include:
Estrogen: The most common form used is 17 beta-estradiol. This can be taken as a pill, or more often, absorbed through the skin using a patch, gel, or spray, which carry a much lower risk of clots. If your doctor suggests a pill, you should challenge them as to why.
Progesterone: If you still have a uterus, you'll need to take progesterone along with the estrogen. This helps prevent thickening of the uterine lining and prevents endometrial cancer. Progesterone is usually taken as a capsule or through a hormonal IUD.
Testosterone: This hormone is now sometimes added to HRT regimens. It can help with issues such as low sex drive, fatigue, and brain fog. While testosterone is usually thought of as a 'man's hormone', women produce it too and its decline can lead to a range of symptoms. Your doctor may need to be pressed to discuss testosterone with you.
Timing is Everything: The Importance of Early Intervention
Studies show that the timing of when we start HRT can make a big difference. According to research published in the North American Menopause Society journal, women who begin HRT during the early stages of perimenopause or within the first 10 years of menopause tend to experience better outcomes, like a reduced risk of heart disease, osteoporosis and cognitive decline. The key is to work closely with your healthcare provider to find the optimal window for you based on your personal hormonal profile and health history.
Tailoring HRT to Your Needs
Today's healthcare providers should be able to provide you with a personalised approach. They'll consider factors like your specific symptoms, your personal and family medical background, and your long-term health goals. This might involve trying out different types, doses, and delivery methods of hormones to find the perfect balance for you.
Integrative Approaches to Hormone Management
While HRT remains a cornerstone of menopausal care, many complementary therapies can also support our hormonal health. These include dietary changes, targeted supplements, mind-body practices, and lifestyle adjustments. For those that don't want to (or can't) take HRT, these options need to be explored, but even for those taking HRT, they will only add better health outcomes and greater relief.
Your Voice, Your Choices: Embracing Shared Decision-Making
As you navigate this stage of life, it's so important to take an active role in your healthcare decisions. After all, you're the expert on your own body and experiences. Your healthcare providers should be your partners in creating a treatment plan that aligns with your personal preferences, values, and long-term goals.
This collaborative approach, known as shared decision-making, empowers you to explore all the available options and make informed choices. For example, when it comes to choosing which type of HRT is best for you, or if you aren't even sure if you want to take it, don't be afraid to ask your doctor to walk you through the pros and cons of each option. And if your healthcare provider doesn't seem to be aware of the latest research or isn't willing to talk you through it, then it may be a good idea to change your doctor.