Whilst there are many mixed views around when it comes to whether or not to use HRT (Hormone Replacement Therapy), for those of us that do, hitting 60 can be something of a shock to the system! After all, what if you have been sailing through your late 40s and 50s feeling great with tons of energy and looking good into the bargain, only for a visit to your GP to throw all of this into chaos.
Read the story of Jane from our Editorial Team, whose own personal experience may mirror your own or from which you may glean some useful advice.
“This happened to me; I went to see my GP to pick up my regular prescription, only to be told, “Sorry, you can’t have any more.” Some doctors may deal with this well but mine didn’t as he was not so much proactive as reactive. Because he was not an expert in the issue of HRT or hormones, he simply told me not to go ‘cold turkey’ but to wean myself off the drug slowly. I finally managed to agree a period of 3 months to do this, but was not looking forward to the process.
“But where does that leave us at 60 and having to give up HRT? Most GPs seem to be against prescribing it after this time, quoting the risk to health as a very big negative. But because most GPs are not trained to help us through this weaning-off period, we can find ourselves hitting a brick wall. Within a few days of cutting my HRT dose I felt extremely tired, foggy headed, moody and totally out-of-sorts. Even my skin started to dry up! With this in mind I carried out my own research and here I am sharing it with you, knowing that being forewarned is forearmed.
Why are we told to ditch the HRT?
Doctors don’t like to prescribe it to women over the age of 60, citing a much higher risk of breast and ovarian cancer as well as heart attacks and strokes. Even if you do your own research, weigh up the risks and decide you would rather go with quality of life rather than quantity, the problem is not over. Most GPs will refuse to write a prescription much after 60 and resorting to buying it off the internet may be downright risky in too many ways.
Most of us don’t realise or don’t get told by our GP that if we suddenly stop taking HRT, menopausal symptoms can come back with a BANG! Whist it was never meant to be taken long-term, you do have to come off it the right way and should not choose the reckless option. If you stop taking it immediately, not only will your body possibly react to withdrawal but this could be on top of old menopausal nasties coming back at the same time.
What are the NICE Guidelines on HRT?
New guidelines from the National Institute for Health and Care Excellence (NICE) are being published to help more women receive the treatment they need to manage the symptoms of the menopause. The guidance could lead to thousands more women being offered hormone replacement therapy (HRT) in the UK.
An estimated 1.5 million women – around 80% of those experiencing the menopause – have some symptoms, while 20% suffer more severely. Symptoms typically last for around four years but in some cases can last as many as twelve. However, in the last decade, research which has suggested a link between HRT and breast cancer has led to a halving of the numbers of women taking the drugs.
The new guidance aims to tackle these declining numbers. The NICE guideline committee says that too many women are suffering unnecessarily with debilitating menopausal symptoms because they are not being prescribed drugs which could relieve them. They say that women should be able to make up their own minds about whether or not to take HRT after discussing the potential benefits and risks with their doctor.
The guidelines also highlight the importance of doctors assessing the appropriateness of HRT and other treatments based on each woman’s personal circumstances, and of addressing the needs of women who experience premature menopause.
The new recommendations include:
- Diagnosing healthy women aged over 45 years with menopausal symptoms as entering menopause if they experience hot flushes and night sweats
- Diagnosing women with menopause if they have not had a period for at least 12 months and are not using hormonal contraception
- Offering women HRT for hot flushes and night sweats after discussing the risks and benefits with patients
- Considering offering women HRT to ease low mood that arises as a result of the menopause, and considering cognitive behavioural therapy (CBT) to alleviate low mood or anxiety
- Explaining to women that oestrogen-only HRT has little or no increase in the incidence of breast cancer, while HRT with oestrogen and progestogen can be associated with an increase in the incidence of breast cancer, which reduces again after stopping HRT
- Not automatically excluding women with cardiovascular risk factors from taking HRT, and explaining that HRT does not increase cardiovascular disease risk when started in women under the age of 60
- Referring women who have had breast cancer and have menopausal symptoms to a specialist to see what treatment is suitable for them
The guidelines also stress that women who have been prescribed menopause treatments but found them ineffective should be referred to a menopause specialist.
“Women should not feel they have to suffer in silence when menopause is affecting their daily lives at work and at home,” says Dr Imogen Shaw, a GP with a special interest in gynaecology who helped develop the guidelines. “The effects of menopause are often misunderstood and underestimated – it can impact on health significantly in both the long term and short term.”
Dr Heather Currie, chair of the British Menopause Society, says: “Our hope is that the guideline will play an important role in raising awareness of all menopausal symptoms, will encourage women to consider lifestyle changes to improve later health, and will clarify uncertainty around both prescribed and non-prescribed treatment options.”
Coming off HRT
Even if your GP does not advise you, it is always best to come off your HRT medication slowly. If you have been using it for 10 – 20 years, your body will have become dependent on it. Whilst natural menopause occurs gradually over time, thrusting your body into overnight menopause is to be avoided. Whatever dose you have been on and whichever method you have used, ask your doctor how to reduce it if you are not sure.
Whilst tablets can be halved, gels that you rub onto the skin can’t, so you may find yourself using HRT every 2 days, then gradually extending the periods. Stronger HRT preparations may have even affected the oestrogen receptors in your body, so that they expect to receive a high dose and if they don’t, they will show you how much they dislike it. But even this will adjust over time so take it slowly and allow yourself some time to maybe feel less than 100%.
Dealing without HRT naturally
As the levels of sex hormones drop in our body, fat cells and adrenal glands take over and produce the oestrogen and progesterone instead. It is therefore essential that you support your adrenal glands for at least three months, before and whilst coming off HRT. As adrenal glands also deal with stress hormones, you need to avoid this and take some time out for yourself to rest and relax.
Phytoestrogens that can be found in food can also help to support oestrogenic activity, boosting your body’s receptors and helping them to regulate your hormones. This is mainly down to diet so include things like seeds, linseed, beans, nuts and pulses in your diet. There are also many phytoestrogen supplements that can help as they contain soya isoflavones and things like sage, red clover and black cohosh. Some vitamin supplements are especially developed to help with menopausal symptoms, such as Menopace.
If you find dropping off the HRT brings back menopausal symptoms, then find out which of these supplements suits you best. There are also many commercially available foods which contain these natural phytoestrogens, such as Burgen bread. Containing both soya and linseed, which is not always easy to include in the diet, this is a wholegrain loaf that may help your body to defeat menopausal symptoms if they try to rear their heads again.
Take it easy on yourself
You are entering another phase of your life so you need to be gentle on yourself and love your body. Give it time to adjust to the new regime and pay more attention to what you eat as well as taking extra special care of your hair and skin. Whilst some women experience little or no side effects when they come off HRT, others may find it tough so don’t expect miracles overnight.
Just remind yourself that HRT was never designed to be used long-term and that if you treat your body well, it will adjust and bounce back, given a little help and support by you.
Finally, could hormone therapy such as HRT play a role as anti-aging hormones are used to try to turn back the years? You may like to read on……..
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