HRT, or hormone replacement therapy, has been prescribed as a ‘cure’ for menopausal symptoms for decades, bringing on a significant reduction in hot flushes, vaginal dryness, and depression associated with menopause, as shown in research trials. HRT was also prescribed in the latter half of the twentieth century as a way to help reduce age-related diseases such as osteoporosis, heart disease, and various types of cancer. However, studies in the past two decades have shown potentially serious side effects for some women taking HRT, particularly if taken long-term, and in women over 60. This article looks at the research behind HRT to dispel some of the common myths believed about its side effects, to help you decide whether this is the right course of support for you during menopause.
How does HRT work?
During menopause, levels of female sex hormones start to decline, which is why you may experience symptoms such as hot flushes, vaginal dryness, mood swings, and sleep disturbances. HRT is designed to replace these hormones, either as oestrogen-only or in a combined HRT, which also includes progesterone. These can be prescribed in many forms, including tablets, patches, gels, and creams.
It is clear from research that HRT successfully helps to reduce menopausal symptoms. For example, women may experience up to 87% reduction in the severity of hot flushes, which for some women could have an immensely positive impact on their quality of life. For those forced into an early menopause by hysterectomy, HRT is also prescribed to help support bone density, due the effects of oestrogen on bone mass.
If you are considering taking HRT or have had a conversation with your doctor about it, you may have heard about many risky side effects from taking the drug. Yet there are a lot of myths and misconceptions about these risks, and it’s important to understand what the research actually shows us, and whether the potential benefits of taking HRT outweigh the risks. Here we look at three of the most commonly held beliefs about HRT, which have been reported widely in the media, and examine the actual evidence involved.
Does HRT make you put on weight?
Many women believe that HRT may make them put on weight, but there is no evidence to support a direct link between HRT and weight gain. However, many women do gain weight during menopause, as this is your body’s way of protecting your bones. Your fat cells produce the oestrogen no longer supplied by your ovaries, which helps to preserve bone density. Metabolism also slows at this time, and the changing hormone levels can also affect your appetite, just as they did during your menstrual cycle. So there are many mechanisms at play around this time which may cause you to gain weight, which means it’s not actually the HRT that’s causing the weight gain.
Some of the side effects of HRT may also include bloating and fluid retention, which can lead a woman to believe she is putting on weight. This is due to the role oestrogen plays in body fluid levels and sodium retention. Bloating can also happen during menopause due to the effect of fluctuating hormone levels on digestive secretions such as bile.
Whether you’re taking HRT or not, as you go through menopause you may need to reduce your daily calorie intake, and include foods which help support your metabolism. These include chilli, black pepper, and green tea. Also include plenty of water to support the body’s balance of fluid.
Does HRT increase your risk of heart attack and cardiovascular disease?
HRT was originally thought to help reduce a woman’s risk of cardiovascular disease, and some research trials certainly seem to support this idea. For example, a 2012 study in Denmark showed that taking combined HRT immediately after menopause for up to 10 years significantly reduced the risk of heart disease, and dying from heart disease.
However, many women have been extremely concerned by trials in the late 1990s, which seemed to show an increased risk of cardiovascular disease from taking HRT. The Heart and Oestrogen Progestin Replacement Study was the first large scale placebo-controlled trial examining the use of combined HRT, and heart attack risk in women with existing heart problems. They found no reduction in the risk of a second heart attack, but also found an increased risk of 52% for heart attack in the first year of taking HRT. This risk did however reduce from the second year of taking HRT.
The Women’s Health Initiative Study in 2002, which involved more than 16,000 women, also showed an increase in coronary problems such as heart attack, as well as an increase in stroke, breast cancer and blood clot risk from taking HRT. However researchers reanalysed their data in 2004, and found there may be a decreased risk of heart attack from taking HRT in the age group 50 to 59, as long as HRT began within 10 years of the onset of menopause: that is, when you start experiencing menopausal symptoms. For those starting HRT over 60, they found a generally increased risk of cardiovascular problems.
Does HRT cause cancer?
It is widely known that research has shown an increased risk of certain types of cancer with HRT use, however this has to be put into perspective and understood in terms of what this means for you as an individual. It is clear that oestrogen-only HRT raises the risk of uterine cancer, because without progesterone, the lining of the womb does not shed, and abnormalities in the uterine tissue can develop. This is why oestrogen-only HRT is now prescribed just to women who have had a hysterectomy.
For combined HRT, research indicates an increased risk of breast cancer, which is not so prevalent when taking oestrogen-only HRT. This was reported in the Women’s Health Initiative Study of 2002, which used a combined oestrogen and progesterone HRT. In fact, the study had to be stopped three years early by the safety monitoring committee, due to the limit for breast cancer cases being reached. Whilst the increased risk may be only around 1 woman per 1,000 taking HRT, this risk is significant if applied to the general population. However, it is comparable to the increased risk of breast cancer from drinking two or three units of alcohol per day.