The first NICE guidelines on the diagnosis and treatment of the menopause have recently been published.
The menopause causes a reduction in oestrogen levels due to the cessation of ovulation. As well as a change to the menstrual cycle the reduction of this hormone can cause a multitude of symptoms such as aches and pains, hot flushes, night sweats, vaginal dryness as well as a reduction in libido, low mood and irritability. In some women theses can be really troublesome and last many years.
HRT is currently the most effective treatment for menopausal symptoms. Historically there has been some reluctance to initiate HRT due to perceived risk of breast cancer, heart disease and stroke. However, current evidence obtained through epidemiological research indicates that these risks are not as significant as previously thought and the benefits of HRT far outweigh the small risks, especially if started below the age of 60.
Specifically, the risk of developing breast cancer in post menopausal women over a five year period is 15 out of 1000 women. The additional risk for HRT users is 4 cases in 1000. This is for women who need both oestrogen and progesterone. This added risk is related to treatment duration and reduces after stopping HRT. For women who have had a hysterectomy there is no need for progesterone to protect the lining of the womb, and therefore there is no added increased risk of breast cancer.
Some studies suggest a reduction in deaths from ischaemic heart disease amongst those taking HRT. There is also a reduction in risk of developing osteoporotic fractures.
Probably the safest way to administer oestrogen is via the transdermal route (skin) such as gels and patches. Progesterone can be administered through MIRENA coils or in a bio identical or micronised fashion as a tablet. Testosterone can also be helpful especially where libido is affected and can also be given transdermally.