Menopause and HRT

Menopause refers to the time when a woman’s periods stop completely, as levels of estrogen, a hormone produced by the ovaries, decline. A woman is said to be menopausal when she hasn’t had a period for 12 months.

Menopause matters because until it happens, women are protected by estrogen from a range of conditions, including heart disease, strokes, osteoporosis (bone thinning), muscle and joint degeneration, and Alzheimer’s disease.

This protection starts to be lost as estrogen levels decline around menopause., which typically occurs in the late 40’s to early 50’s.  Other changes associated with lower estrogen levels include alterations in body fat distribution, with more fat being deposited around the abdomen area, and aging effects on skin and hair quality.

Estrogen protects women because cells all over the body contain receptors to which estrogen attaches to help them function properly. There are estrogen receptors in the brain, heart, bones, skin, genital tract and almost everywhere else you can think of, and this is why the symptoms of menopause are so varied.

After the menopause when estrogen stops being produced, long-term health problems or co-morbidities become more common and in fact, heart disease in women starts to occur as frequently as in men.

But it’s possible to reduce your risk of developing these downstream health problems: Adopting a lifestyle that focusses on a healthy diet, the right kinds of exercise, and that supports your mental health, but also crucially, replacing the hormones that your ovaries aren’t producing anymore, are all things you can do to prepare for a healthy, active future.

HRT

HRT stands for hormone replacement therapy and refers to the use of estrogen, progesterone, and sometimes testosterone to treat menopause symptoms. These hormones are naturally produced by the ovaries, but during the perimenopause, (early stages of menopause before periods stop), their levels start to fall, resulting in the symptoms that many women experience during the menopause transition.

Declining levels of estrogen are also associated with a range of medical conditions, including:

• heart disease and strokes
• osteoporosis (bone thinning)
• muscle and joint degeneration
• Alzheimer’s disease

Other effects of estrogen loss include fat re-distribution and aging effects on skin and hair quality.

The aim of HRT is to replace the estrogen that’s being lost; much the same as we do when we prescribe thyroxine for an underactive thyroid. Replacing the hormones that are no longer being produced relieves many of the symptoms of menopause and reduces the risk of the medical conditions mentioned earlier.

HRT comes in the form of tablets, patches, gels, and sprays, and may consist of a combination of estrogen and progesterone in one preparation, or as separate individual preparations. For example, there are combined estrogen and progesterone tablets and patches, as well as separate ones.

What’s best for an individual depends on their particular circumstances, medical history and preference. However, people with a uterus or womb need to have both estrogen and progesterone, as estrogen on its own causes the lining of the uterus to become thickened, carrying with it an increased risk of cancer. Progesterone counteracts this. People who’ve had their uterus removed, called a hysterectomy, don’t need progesterone and can have estrogen-only HRT.

A woman who’s still having periods (or is within a year of their last period) will usually be prescribed cyclical HRT. This means that they will continue to have a monthly bleed. Women who have not had a period for a year or more will usually have continuous HRT with no monthly bleeds.

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