It may not be necessary. Menopause is not a disease but a natural process; most women experience menopause around the age of 55, and for the majority, if there are mild or occasional symptoms, they will last for between five and seven years and then resolve naturally. So you may not need HRT, says Dr Gareth Lorge, specialist physician at Netcare Rosebank Hospital. Only about two in every ten post-menopausal women will need to seek medical help for their symptoms, and HRT may not be an appropriate solution for all of them.
The first step is to ensure that your symptoms are, in fact, triggered by menopause. “It's not always the case. Certain symptoms, such as changes in your skin, may well be caused by other underlying conditions. Examples are adult-onset diabetes, an underactive thyroid and other endocrine conditions that become more common as you get a little older. That is why every single woman needs to be assessed as an individual by her doctor. Other conditions must be ruled out or treated. Many medications commonly prescribed for women at midlife, too, can cause symptoms - skin conditions like rashes, for instance - so we need to exclude them as possible causes.”
The second step is to assess whether your symptoms are bad enough to need intervention - and if so, if HRT is the best option. For most symptoms you might experience at a moderate level, there are other options for treatment. Working in partnership, women and their doctors can tackle each symptom individually as it arises, and use treatments ranging from the allopathic to the herbal to the homeopathic.
“Just paying more attention to making healthy choices can help women through the period after menopause,” Dr Lorge points out. “Simple things like quitting smoking, starting an exercise programme if you're not on one, avoiding alcohol and eating healthier food can make a big difference. A little weight loss can be remarkably effective; a loss of just a few kilos can reduce blood pressure and stabilise metabolic syndrome, which will make you feel much fitter and able to cope.”
Still, there are those two in ten women who will experience bad, sometimes quite debilitating symptoms that make life unliveable, symptoms like:
A woman who has hot flushes at night which wake her up frequently most nights, which even see her getting up to change linen that she's perspired through, may well feel that HRT is a life-changing option.
Before it is prescribed, says Dr Lorge, it is very important that a careful and thorough assessment is done of her state of health, her health history and family history. “Research is being done on an ongoing basis on HRT, and to be honest, I believe the jury is still out on this treatment,” he says.
“There is research that shows benefits of HRT over and above treatment of post-menopausal symptoms, such as a reduced loss of bone density. On the other hand, there is also research that shows adverse effects, like a slightly increased risk of breast cancer. That is why it is critical that each woman is assessed to weigh the possible risks against the benefits in her case. It is also essential that she is given all the facts she needs to make her own personal choice of preferred treatment.”
Women who have a family or personal history of cancers like breast or ovarian cancer might want to consider other options, as might women who have cardiovascular risk factors. On the other hand, women who are at serious risk of osteoporosis might want to opt for HRT even if their post-menopausal symptoms are not that severe.
For those women whose post-menopausal symptoms are absolutely incapacitating, the decision is relatively simple. “If your doctor is sure that you have no risks that would exclude you from HRT, then your doctor must choose an HRT that is appropriate for you specifically,” says Dr Lorge. And, as with any medication, treatment should not be continued longer than is necessary. “HRT should not be used for longer than five years unless there is a specific reason to do so.”
If you do decide to go onto HRT, what will happen when you come off it at the end of those five years? “By far the majority of women who taper off HRT over three to six months will have no problems. Some might experience a few problems that can be treated symptomatically (for instance, if depression becomes a problem, anti-depressants can be prescribed). In very rare cases, if the severe, debilitating symptoms re-occur; the woman and her doctor can together make a decision about whether or not to continue HRT for a few more years, perhaps trying a different treatment, such as progesterone instead of oestrogen.”
Dr Lorge emphasises that every step of the way, women should be fully informed by their doctors, and fully involved in every decision about treatment. “HRT is not an ogre, as some would have you believe; it has very genuine benefits and can be a life-saver for some. However, no one should embark on a course of treatment - of any kind - if it is not really necessary. I strongly encourage you to involve your family doctor, and allow him or her the privilege of assisting you through this well-earned and hopefully blessed stage of your life.
Menopause is a chance to reassess your lifestyle and health choices, it is not a disease!”
