Menopause & the comeback for HRT
Dr Nadia Oozeerally, at Your Private GP Service, Ashtead Hospital, has a special interest in women’s health, and she has been a passionate advocate for HRT for over 10 years. In this editorial, she explains how Hormone Replacement Therapy (HRT) can help women maintain their mental health, vitality, and sex lives through the perimenopause and beyond.
The ovaries produce the majority of the body’s oestrogen from puberty and this continues until later life when the ovaries start producing less oestrogen and eventually stop altogether. Periods often become less regular and can be extremely heavy with flooding. The symptoms which are classically associated with menopause are actually a result of the body withdrawing to the fluctuations and lack of oestrogen it had been dependant on for most of its life.
Menopause occurs officially when there has been no bleed for 12 months, and the symptoms can persist for years afterwards. The average age of menopause in the UK 51 years of age.
Common perimenopausal symptoms:
• Hot flushes
• Mood swings
• Bleeding irregularities/heavy periods
• Brain fog
• Lack of libido
• Restless legs
Oestrogen in the form of an Oestradiol gel or patch is now the preferred method of prescribing HRT. The Oestradiol mimics the oestrogen which is produced by the ovaries.
Oestrogen has lots of beneficial effects on women:
• Protection from heart disease
• Maintaining bone strength, preventing osteoporosis
• Maintaining brain function, preventing dementia onset
• Maintaining skin elasticity (wrinkle prevention) and hair growth
• Improved quality of life
As well as producing oestrogen, the ovaries also produce the hormone testosterone, which is important in maintaining the woman’s sex drive.
HRT has gone full circle since it was first marketed in 1942, starting as a saviour drug for women suffering with menopausal symptoms, later being linked to increased breast cancer and heart disease in the 1990’s which resulted in dramatically reduced prescribing for a couple of decades. In the last decade, the bad press and old myths surrounding HRT have been replaced by scientifically proven, significant health benefits and thankfully we are seeing a rise in demand again.
There are lots of different ways that HRT can be prescribed now: gels, patches, oral tablets, vaginal tablets and intrauterine systems. The newer methods of prescribing mean lower doses of hormones are needed for the benefits to be seen and much reduced risks of side effects for women.
Gels and patches applied to the skin offer a transdermal route of absorption of the hormones, meaning that the hormones are absorbed through the skin directly into your blood stream. Hormones in the form of a tablet pass through the stomach and gut, and so must be modified in order to withstand the stomach acids and digestive enzymes, which breakdown the medicine and leave us with the hormone we need. It is often the by-products of this breakdown process which can be the cause of unwanted side effects.
Oestrogen and testosterone gels are prescribed together along with some form of Progesterone as a tablet, patch or ideally via an intrauterine system called Mirena (formerly known as the Coil). The progesterone hormone is required for women who have a uterus. Without progesterone, the uterus lining would be stimulated to grow by the effects of oestrogen.
By prescribing a combination of Oestrogen, testosterone and progesterone (if needed) women can now smoothly transition through the menopause maintaining their vitality and health, and without suffering. HRT can be given safely for many years, and for many women, they choose to continue it indefinitely because of the benefits they gain whilst on it.
At Your Private GP Service we offer consultations for women who are interested in starting HRT, in which they will be able to assess suitability for HRT with an experienced doctor and decide which regimen best suits their needs. A general health assessment and further recommendations may be advised to ensure optimum health whilst on their HRT.
HRT consultations £160 (40 minutes)
Dr Catherine Aboud, Dr Nadia Oozeerally and Dr Karen John are the three doctors who work for Your Private GP Service, Ashtead Hospital.
Our GPs are in clinic every weekday, offering face to face and telephone consultations, longer appointments can be booked on request.