The menopause: risks and treatment
By Dr Rebecca Brady, Medical Director, HCML
Everyone’s experience of the menopause journey is different. Symptom variation is immense between women, and changes over time in every single individual. So how do we know how or when to treat?
The recognition of potential symptoms and the fact that they can be treated is the first step. But management of the menopause doesn’t just stop with alleviating symptoms – it is also important to appreciate the long term risks of the menopause
- on bone health: increasing the risk of bone loss and osteoporosis
- on heart health: increasing the risk of heart disease
- on weight: contributing to weight gain and potential risk of obesity which can lead to type 2 diabetes, and
- on cognitive and emotional function: which can lead to an increased risk of mental health issues and is even thought to be linked to dementia.
This is just to name a few.
It sounds overwhelming but it’s so important to be aware and start to look at the menopausal stage of life as an opportunity. I like to call it the ‘mid-life reset’ – a chance for women to actively look at your health and identify ways to prevent illness in the future. Life expectancy has risen so much in the last century that on average women can now expect to live almost half their life in the postmenopausal stage. Therefore, we owe it to ourselves to live it well!
What can we do?
Lots can be achieved through lifestyle: drinking alcohol in moderation, stopping smoking, increasing exercise. These changes will contribute to a healthy body and mind and are really to be encouraged, whatever else you decide to do to manage menopause symptoms.
If you’re asked to consider hormone replacement therapy (HRT), would you? Let’s consider the benefits. Remember that every cell in the body responds in some way to oestrogen. So, it figures that oestrogen has a pretty special role to play in the body’s normal functioning. Not only does it improve symptoms and quality of life, but for the vast majority of women, the benefits of taking HRT outweigh any risks. It reduces all of the long term health risks I’ve described above. So, it’s worth considering.
But what about the breast cancer risk? This is a question I get asked a lot. Unfortunately, breast cancer is common – that is a fact. Women in the UK have a 1 in 8 chance of developing breast cancer at some point in their life, whether or not they take HRT. It is true that there are certain factors which might increase this risk, but many of these wouldn’t even cross our minds: being overweight, not exercising regularly. Others we might not stop doing (drinking alcohol) and others we can do nothing about (getting older, having a history of breast cancer in the family at a young age).
Women under the age of 51 do not have an increased risk of breast cancer from HRT, simply because the HRT is replacing the hormones that their bodies would ordinarily be producing. But they do have increased risks of developing osteoporosis and heart disease, due to their comparative lack of oestrogen.
Furthermore, a common misconception is that oestrogen is the hormone that causes the increased risk of breast cancer. In fact, this isn’t the case and some studies have even shown it to reduce the risk of breast cancer, in women taking oestrogen-only HRT.
In women who need to take a combined oestrogen and progesterone HRT, the risk from the progesterone is far lower with the newer forms of micronised progesterone, than the older forms. In women who take older forms of HRT, the risk remains equivalent to being overweight or drinking two glasses of wine a day.
Finally, although we are talking about breast cancer diagnosis, there is no evidence to suggest an increased risk of death.
Having said all that, I completely understand that some women will just not want to take any risk. And that’s ok – I believe that we all need to make that decision for ourselves. Conversely, there are women who are affected so severely by menopausal symptoms that they would never want to live without HRT!
No article would be complete without mentioning that there are other treatments which women can sometimes find beneficial to help alleviate certain menopausal symptoms, such as some antidepressants to address mental health symptoms and medications to reduce the physical symptoms such as hot flushes. But it’s important to be aware that they don’t provide the same long-term benefits as HRT.
In the end, what works for you is very personal. Speak to your doctor about your options. There is also a variety of information online – check out the Henpicked Menopause Hub and Balance for starters.