Perimenopause and HRT

The menopause

The menopause is the date of your last ever period (meno = period and pause = stop). For most women, the end of periods is a relief and it is the symptoms of low estrogen or the perimenopause that they need help with.

Managing debilitating menopausal symptoms (pdf)

Should I take HRT?

No woman plans to go on HRT. Most women can manage the hot flushes, but when they are every 15 minutes with obvious sweating, when the night sweats wake you up every hour at night, it becomes very difficult to function. Fatigue, depression, foggy brain, anxiety and worse premenstrual syndrome can all be symptoms of the perimenopause.

The hormonal and emotional rollercoaster of the perimenopause can be helped with bio-identical oestrogens and progesterone. A bit of a buzz word, as these are synthesized like all drugs, but they are identical in structure and function to the oestrogen and progesterone produced by the ovaries. On coming off the HRT, the symptoms will return, but since bio-identical hormones are available as a gel or patch, it is easier to slowly reduce the dose.

So if HRT is such a help, why don't women stay on HRT forever?

The answer is that the Women?s Health Initiative and the million women studies discovered an association between oral HRT and breast cancer. The longer you take HRT, the greater the risk. The risk persists for five years or more after stopping the HRT.

Taking HRT for 5 years after the age of 50 to help with the perimenopause transition carries a small extra risk of breast cancer.

Take 1000 women in Europe not taking HRT, 10 women will develop breast cancer in the five years between 50 and 55. If 1000 women in Europe age 50 opt to take HRT for five years, then there would be six extra women who would develop breast cancer i.e. 10 background + 6 extra cases. The riak persists for about five years after you stop the HRT.

Sex drive

Sex drive in the perimenopause can decline, sometimes dramatically. In combination with HRT, topical testosterone gel can help. If vaginal dryness and discomfort on intercourse is a problem (and it can be even if you are on HRT), then vaginal oestrogen pessaries or cream can help.

Information for professionals

Managing debilitating menopausal symptoms, The Practitioner (pdf)