HRT Myth Busters


1) If I am on HRT I don’t need contraception on top…… WRONG!

Average age of menopause is 51 BUT contraception is needed until aged 55

2) All women get menopausal symptoms ……. WRONG!

25% of women get NO symptoms at all. 75% get some symptoms; a third of these women get severe symptoms.

3) Menopausal symptoms last 1-2 years  ………… WRONG!

Average time of symptoms is 7 years but in 20% women they can last for over FIFTEEN years

4) Painful sex and urinary symptoms are part of ageing and I just have to put up with them……. WRONG!

50% of menopausal women get sore and dry in the vulval/vaginal areas as well as recurrent urine infections with frequency.

These debilitating symptoms can be reversed by HRT, even sometimes just by using an oestrogen cream which is NOT HRT

5) I am over 60, I cannot start HRT……… WRONG!

After you have been risk assessed then it may be safe to start HRT. Lower doses are more effective in older women with regular monitoring.

6) I’ve had breast cancer so I can’t use topical oestrogen cream for dryness and recurring urine infections…… WRONG!

SOME women with previous breast cancer can indeed use oestrogen cream

Your oncologist/breast surgeon knows which breast cancer subtype it is safe to use oestrogen cream with. If they agree that oestrogen cream is safe then the lowest possible dose is used to control these symptoms.

7) If I start HRT I will have to have regular periods again which I don’t want………………..WRONG!

Sequential (or cyclical) HRT produces a monthly bleed. It is used in women whose last period was in the last 12 months. We use this HRT for 5 years if started under age 50 then switch to period free continuous combined HRT

If you start HRT after the age of 50, we only need to use cyclical HRT for 2 years before switching.

8) I don’t want to get irregular erratic bleeding pattern if I start HRT…..

This can be avoided by not using continuous combined HRT too soon (i.e. by following advice in point 7)

9) I can ignore new irregular bleeding once I’ve been on HRT for over 6 months…….. WRONG

This should always be investigated so please tell your GP

10) I want to stick to my old tablet HRT and not switch to a newer progesterone or patches or gel……

Older progesterones block oestrogen’s good effects on cholesterol

Newer progesterones help lower blood sugar and insulin production and don’t increase heart disease risk.

Oestrogen protects the heart from heart attacks so women on HRT have less heart disease than those that don’t take it.

There is no clot/thrombosis risk if you use the patch/gel HRT

11) I have a strong family history of osteoporosis. HRT won’t help protect my bones ……………….WRONG!

Even if you only take HRT for 2 years, your bones will get stronger.

If you have menopause before age 40 you should take HRT until at least aged 55 to protect your bones.

Perimenopausal women lose 10 % bone mass. 50% of women will have an osteoporotic fracture after the age of 50.

12) My migraines will get worse on HRT…… WRONG!

Often perimenopausal migraines improve once HRT started

13) I am worried re risk of breast cancer if I take HRT…………………. TRUE BUT alcohol and obesity are higher risks

AND it depends on the type of HRT.

In UK there is a 1 in 7 chance of getting breast cancer whether you are on HRT or not.

The risk due to HRT is TINY but increases after five years of use and is higher with continuous combinded HRT. There is no increased risk taking HRT before the age of 51.

The risk is the same for oral or transdermal forms but micronised progesterones have a lower risk

BUT compared to alcohol and obesity the risk is lower;

BMI of 25-30 results in 4 extra breast cancers per 1000 women

BMI >30  results in 10 extra breast cancers /1000

6 units alcohol/ day results in 8 extra breast cancers/1000

Oestrogen HRT for 5 years results in 3 extra breast cancers/1000

combined continuous HRT results in 8 extra breast cancers/1000

Death from breast cancer isn’t any higher in HRT users despite this very slight increased risk. The risk drops back to ZERO (baseline) once you’ve been off HRT for 5 years.

in other words the risk is as high or higher by being overweight or drinking above recommended alcohol daily limits, hence why this is taken into account when deciding re HRT.

14) What about other cancers and other medical conditions?

HRT reduces the risk of colon cancer

HRT reduces the anxiety symptoms/ mood swings better than antidepressants in some perimenopausal women

HRT improves cholesterol and diabetes control using body identical (micronised) progesterones

HRT improves the condition of skin hair and nails

HRT reduces the risk of dementia

HRT improves sleep

HRT protects bones

HRT protects the heart

HRT MAY reduce brain fog

HRT MAY help joint aches and pains

HRT does slightly increase the risk of ovarian and endometrial (womb) cancers.

HRT in tablet form can increase the risk of clots (thrombosis) and there is a slight increase in strokes.

Dr Hayley Cousins

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