Many women suffer from the effects of hormonal changes at menopause, with hot flushes, night sweats, vaginal dryness and painful sex – often accompanied by mood swings, insomnia, ‘brain fog’ and reduced sex drive. While hormone replacement therapy (HRT) offers relief, in the past 20 years many women and healthcare providers have been reluctant to turn to it for fears around its safety.
The fears stem mostly from a large study by the US Women’s Health Initiative (WHI) in 2002, which found a link between HRT and an increased risk of breast cancer and blood clots. But the study focused on women over age 60, not those who were newly-menopausal, and they were given a specific type of oestrogen and a synthetic progestin.
More recent studies suggest HRT not only controls menopausal symptoms, but is safe when properly prescribed, and that it may even bring health benefits. “HRT has been viewed as the ‘foe’ for many years, where it’s actually a ‘friend’ and can in most instances significantly improve the quality of life of many women,” says Benoni gynaecological oncologist Dr Elize Wethmar.
Myth 1: HRT raises your risk of breast cancer
This is the biggest fear for most women considering HRT. However, the South African Menopausal Society (SAMS) reports that “the absolute risk of breast cancer attributable to hormone therapy is low”. And a large new study in the British Medical journal found risks of HRT were generally low, and breast cancer risk was extremely low for oestrogen-only HRT. However, this can only be taken by women who have had their wombs removed (hysterectomy) – most women take HRT with both oestrogen and progestogen.
The new study found no raised risk of breast cancer for HRT taken for less than a year, but risks rose noticeably if taken longer than five years. The risks dropped when HRT stopped, and five years later there was no increase in breast cancer risk for women who had taken combined HRT for less than five years. Age also made difference, women in their 50s taking HRT were found to be at lower risk than older women. The type of progesterone they took made a difference too – norethisterone was associated with the biggest increase in breast cancer risk, and dydrogesterone with the lowest. Overall, HRT was linked to less than one in a thousand extra cases of breast cancer a year.
Myth 2: HRT increases your risk of heart disease
Recent evidence shows menopausal women who take HRT have no greater risk of dying of a heart attack than women who don’t take it, reports the British Heart Foundation. In fact, if you have early menopause (before age 40), you have greater risk of premature coronary heart disease – and common treatments include HRT.
Myth 3: HRT leads to weight gain
Menopause itself is associated with weight gain or ‘middle-aged spread’ – hormone changes cause belly fat to migrate from hips and thighs, and muscle is lost with age. Far from causing it, HRT may help prevent this increase in belly fat (visceral fat), according to recent research in the Journal of Clinical Endocrinology & Metabolism.
“Being on HRT will increase mood, drive and energy levels, making it easier to exercise,” says Dr Wethmar. “Due to the decreased basal metabolic rate (BMR) that occurs during menopause, exercise is the most efficient way to raise BMR safely, leading to weight loss.”
Myth 4: Bioidentical compounded hormones are safer than approved HRT pharmaceuticals
Bioidentical hormones are made from plant oestrogens such as soy and yams. But SAMS reports that “In South Africa, conventional hormone therapy products require mandatory regulation and registration by the Medicines Control Council. This involves regular testing for purity, potency, efficacy and safety. Bioidentical hormone and compounding products require no such regulation.” It adds that there is “no evidence to support claims of greater efficacy or safety for bioidentical hormone therapy”.
Myth 5: Complementary medicines and therapies are as effective as HRT and safer
SAMS reports that complementary and alternative medicines have become popular because of the “mistaken believe that ‘natural’ medicines have no adverse effect”, but that there is no such thing as natural medicine – all medicinal products are manufactured in factories. It notes that phyto-oestrogens are mainly sourced from soy and red clover. “Most studies have shown a null effect or at most a minimal effect on vasomotor symptoms (hot flashes and night sweats) in comparison with a placebo.”
Last word from Dr Wethmar: “It’s always so interesting to me that when you purchase a car, nobody tells you about the incidence of a life-changing accident while driving, yet we endlessly counsel patients about small risks associated with HRT. I view HRT as a car, easing the route from point A to B. You can walk and sweat, or take the car with minimal risk and feel more comfortable.”
Also read: "I didn't know it was perimenopause"
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