Menopause: Common Myths, Where to Find Help, and Why HRT Could Help You

Are the rumours surrounding HRT’s link to breast cancer true? Is it better if I try to get through the menopause without HRT?

Lexie: Lexie explained in a recent Thrive4Life talk, “death is natural, but there are good and bad ways for it to happen”, and the same is true of the menopause! Whilst some women may not experience many symptoms or feel they need medical intervention, HRT can vastly improve the lives of many women struggling with the effects of the menopause.

As Lexie explained in her “Top Tips for Managing Menopause” talk with Thrive4Life, twenty years ago, a study drew some links between HRT and cancer. Just like the MMR vaccine’s supposed connections to the development of autism, medical professionals are still struggling to break this association, despite proving the invalidity of these concerns. These findings were based on an outdated form of HRT that was made from horses’ urine and synthetic progesterones. Today, HRT is made from a progesterone that comes from yams – this is called Utrogestan. This progesterone is a far cry from the type used in the study – it has a significantly better safety profile and displays brilliant evidence of being breast-safe.

However, it is important to acknowledge that everyone has a background risk level of breast cancer, and this is a risk that is slightly higher if you’re on HRT or the combined hormonal contraceptive pill. However, lifestyle factors such as smoking, drinking excessive amounts of alcohol, or being overweight also contribute towards your risk levels. This puts HRT into context with other factors that many of us might not consider have the potential to be as influential a contributor to our cancer risk levels.

Nowadays, HRT is also taken transdermally, meaning it’s absorbed through the skin. This is much safer than oral administration (which is how it used to be prescribed), as there is less risk of clotting. Furthermore, estradiol (a mixture of oestrogen, progesterone, and testosterone that is normally produced in follicles in the ovaries) is now used instead of synthetic oestrogen, which means that HRT can now be safely prescribed to women with a history of blood clots, hypertension, or migraines.

These improvements mean that almost every woman can take HRT without concern. However, if you have or have had an oestrogen dependent type of breast cancer or you’re living with active liver disease, your options might differ. Yet, as explained by Lexie, “all women should be allowed to have the conversation about what suits them amongst these risk factors”.

Every woman is different, and the decision to use HRT should always be based on an individualised assessment of the potential benefits and risks for each patient, considering factors such as the severity of menopausal symptoms, personal health history, and family history of breast cancer.

How do you take Hormone Replacement Therapy?

HRT is available in various forms in the UK, including tablets, patches, gels, creams, and vaginal rings. You might be prescribed Qlaira or Zoely – Lexie recommends these as they contain body identical estradiol (a mixture of oestrogen, progesterone, and testosterone that is normally produced in follicles in the ovaries), which is in just the same form as the body would usually expect to receive it in. The specific type and format of HRT prescribed to you may depend on your symptoms, preferences, and medical history.

For example, some women may prefer the convenience of a daily oral tablet, while others may prefer a patch that can be changed once or twice weekly. Vaginal rings and creams may be recommended for women who experience vaginal dryness and discomfort during sex. As Lexie explains, replacing a woman’s oestrogen vaginally through the use of a vaginal ring can restore the vaginal microbiome and pH, making her more comfortable and preventing recurrent vaginal infections and UTIs that occur as a result of a lack of oestrogen.

It’s not just oestrogen that women experience a loss of during the menopause – it’s also testosterone, and research in this area is just starting to grow. Lexie explains that many women experience a loss of their “vavavoom” during the menopause, and this is also largely due to testosterone, as declining levels can interfere with doping receptors, decreasing happiness levels. At the moment, very low doses are being trialled, but it is thought that the next few years will see this become more common within HRT treatment plans.

It is important to note that HRT should only be prescribed by a qualified healthcare professional after a thorough assessment of an individual’s medical history and risk factors. Additionally, regular check-ups and monitoring can ensure the safety and effectiveness of HRT treatment.

What effect can HRT have on the lives of women who are suffering from life-limiting perimenopausal, menopausal, or postmenopausal symptoms?

Over the years, Lexie has helped countless patients regain their lives with the help of HRT. In her recent talk in collaboration with Thrive4Life, she shared some of her patients’ stories.

“A 40-year-old teacher came to see me. She was experiencing debilitating headaches which were so crippling she was being forced to stay at home and take lots of time off work, and she just simply couldn’t get on top of these hormonal migraines. She’d suffered for years. Because she still needed contraception, I put her on a continuous progesterone-only contraceptive pill, and she hasn’t had a migraine for two years – simple as that.

Another lady I saw was a senior HR director, who’d just taken on a really big role. A couple of weeks in, she phoned me and said, ‘I think I’ve made a really big mistake by taking this job’. She showed me lots of Post-It notes all over her wall and explained that every time she had a meeting, this is what she had to do. She used to be able to go into meetings and freely communicate everything she needed to, but suddenly she was finding she couldn’t remember anything. She had to take so many notes in with her and write so many notes as she left, she felt like she was losing her mind. She just said that she felt like she couldn’t do it anymore. Luckily, the company she was working for were really good at supporting their colleagues, and this definitely helped. However, I also got her HRT regime sorted, which has made a huge difference to her anxiety levels, sleep, and overall ability to cope. She’s in a completely different place now.”

For many women, HRT can be a lifeline. By restoring their hormones, women can live their lives to the full once more. Lexie explains that she’s seen “women really blow up their lives in their forties – making big decisions about relationships, leaving their jobs, because that’s so much to deal with on top of everything else that’s going on inside their bodies”. Often, the root of all these markers of turbulence is the menopause and the symptoms it causes.

If you’re struggling with symptoms of the perimenopause or menopause, how can you get help?

If you are struggling with symptoms of perimenopause or menopause, it’s so important that you reach out and get the help you need. Lexie recommends doing the following:

• Contact your GP and explain what you’re going through. Before booking an appointment, ask for a Nurse Prescriber (who often have additional training and experience when treating symptoms of the menopause) or anyone with a particular interest in the menopause (this could be a GP or nurse).
• If you have a history of oestrogen positive breast cancer and you’re struggling with symptoms of the menopause, ask your GP to refer you to a menopause specialist. This is because your needs will be more complex and might need to be managed in another way due to the medication or treatments you have been on/are on currently.
• Download apps to help you track your symptoms and learn how to speak to your GP. Louise Newson has released one called Balance, which is excellent for this[1].
• Join a support group: joining a group can be really helpful for emotional support. It can also give you the opportunity to connect with other women going through similar experiences.
• Make lifestyle changes: eating a healthy diet, exercising regularly, and reducing stress may help alleviate some menopause symptoms.
• Reach out! Speak to friends, family members, and colleagues you trust. To break the taboo surrounding the menopause we need to learn to talk to each other and share our experiences. You might know someone who’s going through exactly the same things as you are.

It’s important to remember that the menopause is an entirely natural and normal process, but it can be exceptionally challenging for some women. You shouldn’t have to put up with debilitating symptoms that affect your home life, work, or overall wellbeing. Don’t hesitate to seek help if you have any concerns about your health.

Is it normal for menopausal or post-menopausal women to experience some level of urinary incontinence?

It is common for menopausal and post-menopausal women to experience some level of urinary incontinence. This is because oestrogen is essential in the proper functioning of the bladder trigone, which controls the release of urine and the urge to urinate, and decreasing levels of oestrogen affect this mechanism. However, urinary incontinence is not normal – it’s never something anyone should have to accept as a standard part of ageing.

In Lexie’s words, urinary incontinence should never be normalised. “Women joke about crossing their legs or not going on trampolines, but I think anything that’s life-limiting is wholly unacceptable. Women frequently just cope and cope and cope, and put up with more and more because they have so much going on in their lives. Often, I’ll ask one of my patients how they bladder is, and they’ll just say, ‘oh, it’s fine’. So I say, ‘so you can jump up and down every day?’, and they’ll explain that actually, they do have to wear an incontinence pad every day. That is not fine – no woman should be walking around struggling with the effects of incontinence”.

There are treatments which can help with this, including HRT, which we’ll be diving into in the second part of this blog post. Remember: if you’re concerned about any symptoms of the menopause, it’s essential that you seek professional medical advice.

How can we improve our approach towards the menopause?

Discussion surrounding the menopause is growing, but we still need to improve the way we approach it. We can do this by:

• Increasing education and awareness – education and awareness can help women and their loved ones better understand the menopause, its symptoms, and all the available treatments.
• Encouraging open communication between women and medical professionals, as well as among family and friends, can help women feel more comfortable discussing their symptoms and seeking help.
• Personalising treatment plans – every woman experiences the menopause differently, and treatment plans should be tailored to each woman’s individual needs, concerns, and preferences.
• Addressing the stigma and misconceptions surrounding the menopause which can often prevent women from seeking help and support. Addressing these issues can help them feel more comfortable in getting the medical advice they deserve.
• Fostering a supportive environment – creating a supportive environment for women going through the menopause can help reduce stress and anxiety and improve overall well-being.
  • At work, this might look like making sure staff have access to toilet facilities all the time, thinking about the clothes employees have to wear (e.g., do they have a uniform? If so, is it breathable, or could it pose potential issues for women struggling with temperature regulation?), and creating an environment where employees feel they can speak out if they’re struggling with the effects of the menopause on their lives.

By improving our approach towards the menopause, we can help women navigate this important life transition with greater ease and comfort.