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What are the Alternatives to HRT?

Private GPs

In this post, our private GPs have summarised some of the symptoms you may experience during the menopause and some non-hormonal approaches for managing them. Members of the British Menopause Society, our private doctors Hala and Lucy have a special interest in the menopause.

Many women opt to avoid using Hormone Replacement Therapy (HRT) during the peri-menopause and menopause due to concerns about risk (which we address in this blog post). This may be due to personal or family history of breast or gynaecological cancers.

Vaginal Dryness

Vaginal oestrogen creams, pessaries or a vaginal ring which contains oestradiol can treat Vaginal dryness. This mimics the oestrogen a woman would produce before becoming menopausal. Unlike HRT, there is no systemic absorption so these don’t carry the risks that HRT would.

Vaginal rings can help prevent recurrent urine infections women can be plagued with following the menopause. Vaginal moisturiser and silicone-based lubricants are also very good if sex has become painful.

Ospemifene is a selective oestrogen receptor modulator that has an oestrogen-like effect in the vagina. It is non-hormonal and is being used to treat vaginal atrophy, and it may prove invaluable for oestrogen receptor-positive breast cancer sufferers.

Prescriptible Drugs for Hot Flushes and Sweats

The jury is still out about this, but low doses of SSRIs and SNRIs (forms of antidepressants) have been shown to reduce hot flushes and night sweats, as has a drug called Gabapentin which is often used for atypical pain or epilepsy.

Pregabalin is a controlled drug which has similar results to Gabapentin. It seems to be better tolerated but is more expensive. Clonidine is the only licensed medication at present but isn’t suitable for patients with a low baseline blood pressure.

Alternatives to HRT

Potential Alternatives to HRT

Always seek a medical professional to discuss the management of menopause symptoms. If you’d like to speak to one of our private GPs about the alternatives to HRT, please call our practice on 0333 050 7338.

  • Pregnenolone – This seems to work well for the ‘mind fog’: poor concentration, poor memory, and poor sleep cycle associated with perimenopause and menopause. This is a non-licensed drug via private prescription only.
  • 5HTP – This is a non-licensed drug via private prescription only. The dosage is 100mg at night; it is also said to be good for sleep.
  • Vitamin D – Low levels of vitamin D are associated with low bone density and tiredness. It’s an essential vitamin to take especially during the British winter. 800-1000 units a day are recommended for maintenance therapy.
  • Evening primrose and fish oil – This works well for breast tenderness.
  • Magnesium – This proves to be good for anxiety and labile mood.
  • Chromium – Good for sugar cravings.
  • Multi-Vitamin B – Some evidence suggests that vitamin B may help with stress-induced anxiety.
  • Black cohosh, isoflavones and St. John’s wart – the jury is still out on this. Don’t take this without telling a doctor as it can interfere with liver metabolism and stop other important prescription medication from working. Breast cancer survivors should not use them.
  • Acupuncture – women do report some improvement in symptoms after having acupuncture treatment but studies show this is likely to be a placebo effect.
  • CBT – there’s good evidence that CBT can help with low mood and anxiety caused by the menopause.

One of the most important factors to consider is lifestyle as this can play a huge part in symptom relief. Cutting back on alcohol, spicy food and caffeine will help ease symptoms. Plus, weight loss (if BMI is over normal range) can be very helpful.

Smoking will make hot flushes worse and increase cardiovascular risk. Aerobic and weight-bearing exercise reduces flushes and sweats and it could increase bone density.

Fezolinetant

Fezolinetant is a new drug; it’s undergoing studies and currently only available in research settings. However, all of the evidence is pointing toward the fact it may help with hot flushes and sweats in women who cannot have hormonal treatment.

If you’d like to speak to our private GPs about the alternatives to HRT or to find out more about the symptoms of menopause, contact us on 0333 050 7338.

What are the Benefits and Risks of HRT?

Private GPs

Here at Linbury Doctors, our private GPs Hala and Lucy, are members of the British Menopause Society and have undertaken training in the menopause. This series of blog posts delves further into the science behind menopause, and how to treat symptoms. In this post, we discuss the benefits and risks of Hormone Replacement Therapy (HRT).

If you haven’t read our previous blog post about what HRT is, you can do so by clicking here.

Misconceptions of HRT: The Million Women Study

Concerns over HRT safety were raised in 2002 and 2003 by the Million Women Study. The two main concerns raised were an increased risk of breast cancer and a raised risk of cardiovascular disease.

An urgent safety warning was released and the numbers of women taking HRT fell by 66%. That has only just started to change after 10 years so we have a whole decade of women who have mostly been denied the opportunity to benefit from HRT.

Many doctors stopped prescribing it and the workforce deskilled. The women in the study were north American, mostly overweight, often in their mid-sixties and therefore were not representative of who HRT would be appropriate for from a risk profile point of view. There has since been a retraction of some of the findings and recent studies have shown there is no increased cardiovascular risk on women who start HRT within ten years of starting the menopause.

benefits and risks of hrt

HRT risk can be lowered if:

  • Taken for the correct reasons
  • Taken for as long as necessary at the lowest possible dose
  • HRT users have access to their GP at least once a year

Proven Benefits:

  • Control of menopausal symptoms
  • Maintenance of bone density and reduced risk of osteoporotic fracture

Potential Benefits

  • Reduced coronary heart disease risk
  • Reduced risk of Alzheimer’s when started early
  • Reduced colorectal cancer risk
  • Reduced risk of type 2 diabetes

If you’d like to speak to our private GPs, please get in touch with us on 0333 050 7338. Here at Linbury Doctors, we put our patients at the core of everything we do and always provide premium healthcare and advice.

Risks of HRT

Blood Clots

This risk is only applicable to oral preparations and not on the patch or gel. There is a raised stroke risk when oral HRT is started in women over 60.

Cardiovascular risk

This risk is only if HRT is started over the age of 60. Studies have shown that if HRT is started within 10 years of the menopause, it may actually reduce the risk of cardiovascular disease.

Breast Cancer

HRT does not affect the risk of dying from breast cancer. HRT with oestrogen alone is associated with little or no increase in breast cancer. HRT with oestrogen and progesterone can be associated with a small increase in the risk of breast cancer.

The current view is that HRT may promote the growth of breast cancer cells already present rather than causing the breast cancer itself. It should be noted that being overweight or drinking more than 14 units of alcohol a week carries a higher breast cancer risk than HRT.

There is likely to be an extra 3-4 cases of breast cancer per 1000 women after 5 years use of HRT after the age of 50, if started within a ten-year window of the menopause.

Linbury Doctors Private GPs

If you’d like to find out more about the benefits and risks of HRT, get in touch with our private doctors on 0333 050 7338. We can advise you on the best course of action if you are suffering from the symptoms of menopause.

What is Hormone Replacement Therapy (HRT) and Bioidentical HRT?

Private GPs

Our private GPs, Hala and Lucy, have a special interest in the menopause and are members of the British Menopause Society. In this blog post, they delve into the treatment of menopause symptoms and how Hormone Replacement Therapy (HRT) works. If you’re experiencing any symptoms of menopause or would like to talk to a healthcare professional, do get in touch with our private doctors on 0333 050 7338.

What is HRT?

Hormone Replacement Therapy is used for the treatment of menopause symptoms, such as night sweats and hot flushes. It works by replacing hormone levels that drop as you approach the menopause.

All types of traditional HRT contain oestrogen so it’s often started at later stages when progesterone levels are very low and oestrogen levels start to drop.

Administering HRT

HRT is also needed in premature menopause to maintain bone density. It’s important to note that, if you still have a womb (no hysterectomy) and just take oestrogen, the womb lining could build up and become a cancer risk. Therefore, HRT is co-prescribed with a generic dose of progesterone to stop this from happening.

Sometimes both oestrogen and progesterone are synthetic, and sometimes just the progesterone is. This means that these synthetic hormones are not identical to the ones found in the human body and are given in standard doses. If you are still having periods, it will be given in a cyclical manner. If your periods have stopped, it will be given continuously.

The benefits of HRT include reduction of night sweats and flushes, reversal of vaginal changes, improved mood and sleep. It can also help with joint aches and pains, skin and hair texture, as well as reduced bone thinning. Evidence concerning heart disease and dementia prevention is still controversial.

What is HRT

What are the risks?

The risks of taking HRT include blood clots in the veins, breast cancer in women over 50 (note there is no increased risk in women under 50), a small increase in risk of stroke, and possible increase in risk of ovarian cancer which goes on stopping the HRT.

The most important thing to bear in mind when discussing risk is to consider personal and family medical history. So, each case must be thoroughly discussed with a doctor. Our private GPs can help advise you in the best course of action. If you’d like to get in touch, please contact 0333 050 7338.

Contraception

HRT doesn’t act as a contraceptive. So, you would need to continue your method of contraception for two years if your last period took place under the age of 50, or for one year if your last period took place when you were over 50.

HRT can be given in combined tablet (carries a clot risk), a combined patch (no clot risk) or in the form of a gel or patch (no clot risk) in combination with a Mirena coil.

Bioidentical HRT

The aim of bioidentical HRT is that both hormones – oestrogen (in the form of oestradiol) and progesterone – mimic those that are produced naturally before the menopause.

It would be wrong to call bioidentical HRT ‘natural’ as you are still replacing something that a woman wouldn’t be producing after going through the menopause.

Bioidentical HRT is normally given in the form of an oestradiol patch or gel along with a progesterone capsule called Utrogestan that is taken at night. The benefits of it from the point of view of reliving menopausal symptoms should be identical to that of traditional HRT.

About 1 in 20 women cannot absorb through the skin and therefore find the patches and gels ineffective at relieving their symptoms. This is the same for both the traditional and bioidentical HRT approach. Bioidentical HRT is still relatively new but, to date, the safety data is looking really good; it is pointing towards the fact it may be lower risk than the synthetic HRT approach.

Here at Linbury Doctors, we are delighted to offer doctors with specialist menopausal training; they are experienced in prescribing bioidentical HRT. If you’d like to speak to our private GPs, please call the practice on 0333 050 7338, or email info@linburydoctors.co.uk.