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Health information, HRT, menopause

The Menopause

New evidence on HRT patches

The menopause occurs when women stop having periods and is no longer able to get pregnant naturally. It usually takes place between the ages of 45-55 as oestrogen levels decrease, but in 1% of women it occurs before they are 40 years old.
Women are born with a fixed number of eggs and, when these run out, the natural level of hormones in the body changes. Although the menopause is usually a normal stage of life it can be caused by treatments for cancer, by surgery on the ovaries and by some medical conditions such as Addisons Disease.

Symptoms

The symptoms of the menopause can begin years before periods stop and, although they usually subside within four years of the last period, they can continue for much longer.

Typical symptoms include hot flushes, night sweats, discomfort during sex, difficulty sleeping, low mood or anxiety and reduced sex drive (libido). Some women also experience mood changes, headaches, palpitations and repeated urine infections. Longer term, there’s a greater risk of developing osteoporosis when the bones get thinner and more prone to fractures.

Treatment
The menopause can’t be avoided but the symptoms can be alleviated for many women. The most common treatment is Hormone Replacement Therapy (HRT). It’s available as tablets, patches and gels and there are two main types:

  • Combined oestrogen and progesterone for women who still have their womb (uterus) because oestrogen taken alone can increase the risk of developing uterine cancer
  • Oestrogen-only HRT for women who’s womb has been removed.

Other treatments include Cognitive Behavioural Therapy (CBT) for mood changes and medicines like clonidine, gabapentin and venlafaxine for hot flushes.

Side-effects of HRT

HRT is effective but it’s use should be weighed against various side-effects. The most common are breast tenderness and vaginal bleeding, but there are a number of more serious conditions as well:

  • Heart disease and stroke
    Women taking combined HRT have a slightly higher risk of developing heart disease and of having a stroke (about five extra women out of every 1,000 taking combined HRT for 7 years)
  • Breast cancer
    Various types of cancer are sensitive to hormone levels in the blood. The best evidence about HRT is that it causes about five extra cases of breast cancer for every 1,000 women using combined HRT over a 7 year period, and about eight extra cases per 1,000 women in the 7 years after they stop using it (the baseline is that about 22 women in every 1,000 develop breast cancer over a seven year period).
  • Deep vein thrombosis
    A Deep Vein Thrombosis (DVT) is a blood clot that develops in the deep veins of (usually) your legs. Whilst they are painful and can cause permanent leg swelling, the main danger is that a fragment can break off and travel to the lungs – a Pulmonary Embolus (PE). This can lead to breathing problems or even sudden death. If you develop a DVT or PE, you need months of treatment with blood thinners, which carry their own risks. The risk of getting a DVT is about 60% higher if you use HRT tablets (and ranges from 20-100% depending on the mix of hormones used) – about nine women in every 1,000 will develop one over a ten year period. However, new research suggests that there’s no increased risk if you use patches rather than tablets. Most women in the UK use tablets, so there’s lots of scope for change.
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