Menopause and HRT
The menopause is a natural state that happens as a woman’s natural oestrogen production declines.
We believe that all aspects of medicine should be individual to every patient, but in the menopause transition this is particularly important. There should be a focus on lifestyle and holistic care, as well as possibly treatment with hormonal or non-hormonal medication options.
Please take a look at the information below, and the links provided.
If you are not already on HRT, and have read the information on this page – and would like to discuss the menopause or HRT further with a surgery clinician:
1. Download, print, complete and return this questionnaire (click here) to Reception.
2. Fill out an eConsult (click here) and let us know you’d like to discuss menopause/HRT. eConsults are sent to a GP at the surgery who will get back to you within three working days.
Please have your current weight (in kg) to hand, as well as your height (in cm). If possible, please also have a recent blood pressure reading to hand. If you can’t do this at home, you can make an appointment at the surgery to have your blood pressure checked.
Please be aware:
Starting HRT can mean multiple prescriptions and changes to prescriptions in the beginning. It might be worth considering a pre-payment prescription plan. Please follow this link for more information: https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-prescription-prepayment-certificate-ppc
From 1st April 2023, women prescribed HRT will have access to a new scheme enabling access to a year’s worth of menopause prescription items for the cost of two single prescription charges (currently £18.70). As part of commitments to reduce the cost of HRT for menopausal women, the prescription prepayment certificate will be valid for 12 months. It can be used against a list of HRT prescription items, and a patient can use this against an unlimited number of HRT items, such as patches, tablets and topical preparations.
Definitions
Menopause
When you do not have a period for 12 consecutive months. Technically this is a single day in time. The time before this when you have menopausal symptoms being the perimenopause, and the time after being post-menopause.
(While the average age of menopause in the UK is 51, it can happen a lot earlier for a reasonable number of patients. 1 in 10 patients can go through it before age 45, and 1 in 100 before age 40)
An informative video from the British Menopause Society can be found here.
Perimenopause
This is a variable period of time before the menopause (and can be up to 5-10 years before the menopause).
The symptoms we get in the perimenopause are a reflection of hormonal fluctuations and a general decline in functioning of the ovaries. You may have some symptoms but still have your periods which may be changing in nature and frequency.
Treatment can be started in the perimenopause (before your periods naturally stop) to help with some symptoms. The symptoms can get worse as we transition into the menopause and early post-menopause years, and this is a reflection that our ovaries are no longer producing eggs.
Post-menopausal
This is the term for the part of your life AFTER your periods have stopped.
This is characterised by low oestrogen levels, and this can bring with it health risk changes such as an increased risk of Osteoporosis (brittle bones) and an increased risk of cardiovascular disease and genito-urinary symptoms.
The average age of death in the UK is 83 – this means that we can live around 1/3 of our lives in the post-menopause phase, so it’s worth thinking about how we can live these years as healthily as we can.
Why does the menopause happen?
As the ovaries age, the store of healthy eggs declines, and the oestrogen made by the ovaries also reduces with it.
Our ovaries make most of the oestrogen needed by the female body. Oestrogen carries out many jobs around the body – pretty much all cells in the body have oestrogen receptors (places where oestrogen lands on the cell, causing it to behave a certain way). This means that a reduction or loss of oestrogen can cause a range of symptoms.
Symptoms of the menopause/perimenopause
Every woman’s experience of the menopause transition is different. Not all women will have all these symptoms, and they can be mild, severe, or anywhere in between.
Symptoms generally last between 4-7 years, however in one third of women they can go on for longer than this.
Considering treatment
Above all, the menopause transition should be about teaching women about what’s happening and what to expect, and making an informed decision for what you feel will suit you as an individual.
Hormone Replacement Therapy (HRT) replaces the hormones that your body has stopped making on its own. This is the menopause treatment that will most likely have the biggest effect on your symptoms.
Not all women will decide they “need” HRT, and some will decide that in their personal circumstances, they would prefer not to use it, or can’t safely be prescribed it. There are other non-hormonal options for support in this transition if HRT is not suitable for you.
There are more specialist support services via the Endocrine clinic at the Breast Centre at Torbay Hospital – this is available for women who have had oestrogen-positive cancers. Please speak to the Breast Clinic or our team at the surgery for more information.
It is important to remember that for most women below the age of 60, or within 10 years of the menopause, the benefits of HRT will outweigh the risks.
If your symptoms are having a significant impact on your quality of life in your home, work, social or sex life, and you and your doctor agree the benefits outweigh the risks, then HRT may be a reasonable choice for you.
There are a number if different types available, so it’s worth reading about these to inform your choice.
More information can be found on this page (click here), and this video by the British Menopause Society talks in more detail about HRT (click here).
How long you are on HRT for, will be an ongoing conversation between you and your doctor.
While you are on HRT, you should be assessed at least annually.
Women who go into the menopause early should strongly consider HRT, generally until at least age 51, to lower the risks associated with the lack of oestrogen. These include:
- Those who have had a “surgical menopause” – for example, if ovaries were removed at the time of a hysterectomy.
- Those with a “premature menopause” or premature ovarian insufficiency.
https://www.daisynetwork.org has more information.
Benefits and risks of HRT
There has been a lot written about HRT in the media over the years, and in times past there were a number of “scares” over the safety of HRT.
While the research in all women’s health is generally lacking, the best evidence we have now shows that while HRT is not risk-free, it is a relatively safe and effective treatment for most. During an appointment about the menopause, we would assess each patient to weigh out the benefits and risks to them as an individual.
The links below give more detail, and they are important to read to inform further discussions at an appointment with your GP:
https://pcwhf.co.uk/wp-content/uploads/2018/11/HRT-Myths-Uncovered.pdf
https://thebms.org.uk/wp-content/uploads/2023/01/WHC-Infographics-JANUARY-2023-BreastCancerRisks.pdf
This video by the British Menopause Society discusses breast cancer risk with HRT (click here)
What if I don’t want HRT or can’t have HRT?
This article talks about other options:
https://patient.info/womens-health/menopause/alternatives-to-hrt
This link tells you about non-hormonal alternatives that can be prescribed, other than HRT:
https://www.menopausematters.co.uk/prescribed.php
This link tells you about lifestyle options and herbal preparations or “natural” options – keep in mind “natural” does not always mean “safe”:
https://www.menopausematters.co.uk/otherpreps.php
We are very lucky to have access to Devon TALKWORKS who are able to deliver specialist British Menopause Society “Cognitive Behaviour Therapy for the Menopause”.
This has good evidence for the treatment of hot flushes and mood effects related to the menopause. This is a self-referral service so please follow the link below for more information:
https://www.talkworks.dpt.nhs.uk/menopause-mental-health
What about contraception?
It is still possible to conceive naturally in the perimenopause, and on the whole, you should assume you need to use contraception:
- Until age 55, or
- Until at least 12 months after your last natural period if you are over 50, and 2 years after your last natural period if you are under 50.
Certain kinds of contraception may be more suitable than others for women at this stage of life. The link below has more information that you may find helpful:
Holistic support and Keeping healthy
It’s important to think about maintaining your general health as toy enter the perimenopause and beyond. Do not forget to book in for your routine screening tests – you will usually be invited by letter:
- Cervical screening for all patients aged 25-64 with a cervix: https://www.nhs.uk/conditions/cervical-screening/
- Breast screening for all patients aged 50-70: https://www.nhs.uk/conditions/breast-screening-mammogram/
There are other things you can do to maintain your health in the perimenopause:
- Maintain a healthy weight, or try to lose weight if you are overweight.
- Stop smoking – smoking significantly increases the risk of heart disease and strokes, Osteoporosis, most types of cancer, and many other diseases. Stopping smoking is one of the best things you can do to improve your future health.
- Exercise – there are many benefits from exercising to both your physical and mental health. Regular aerobic exercise can help in lessening the impact of hot flushes, and improve sleep. It can improve mood and lower stress. It can also help you maintain a healthy weight and lower your risks of heart disease and stroke. Weight-bearing exercises and yoga can improve bone density and balance, which lowers the risk of fractures due to Osteoporosis.
- Diet – controlling your cholesterol and triglycerides, and eating a low-processed, high plant-based and low Glycaemic Index diet can help to lower the chances of developing heart disease, strokes, and diabetes.
- Reducing caffeine and alcohol intake – both of these can contribute to poor sleep and also hot flushes and sweats, so lowering your intake can sometimes help your symptoms. Alcohol also increases your breast cancer risk.
- Good “sleep hygeine” – click here for more information on how to sleep better.
- Good vulval and pelvic floor health – pelvic floor exercises can improve urinary continence, help to prevent prolapse of the pelvic organs, and improve your sex life. The Gynae Physio (self-referral – 0300 004 0335) is an excellent service which offers 1:1 support and reviews, as well as group education. Avoid soaps or foaming washes as these can be irritant or drying if they create a foam. Use of an emollient for washing the vulval area, such as Hydromol ointment, Cetraban, Diprobase or any similar emollient is a great soap substitute.
Vaginal hormonal and non-hormonal treatments
Vaginal oestrogens
Topical vaginal oestrogens are very safe, and nearly all women can use them, even if some other forms of HRT are not suitable.
They are excellent treatments for preventing the genital and urinary symptoms that come with a lower-oestrogen state that generally starts in our post-menopausal years and beyond.
It can help symptoms of vulvan, vaginal or urinary discomfort, infections, itching, burning, dryness, and discomfort during sex.
They need to be used regularly to maintain their helpful effects.
Vaginal moisturisers such as YES, Hyalofemme, Replens and Sylk can be helpful. These can be used alongside the vaginal oestrogens, and can be bought online or over-the-counter.
https://www.yesyesyes.org gives good information on vaginal moisturisers and intimate lubricants.
More information
Please feel free to take a look at the range of informative videos from the British Menopause Society:
https://www.youtube.com/channel/UCz9m2gNQgI-2QCawAzgWC7w
Further information about managing the menopause can be found at Women’s Health Concern (click here).
However, if you want more information or would like to discuss menopause or HRT further, you should speak to a GP at the surgery to take a look at your individual options and what may work best for you.
If you would like to speak to someone at the surgery:
1. Download, print, complete and return this questionnaire (click here) to Reception.
2. Fill out an eConsult (click here) and let us know you’d like to discuss menopause/HRT. eConsults are sent to a GP at the surgery who will get back to you within three working days.
Please have your current weight (in kg) to hand, as well as your height (in cm). If possible, please also have a recent blood pressure reading to hand. If you can’t do this at home, you can make an appointment at the surgery to have your blood pressure checked.
Please be aware:
Starting HRT can mean multiple prescriptions and changes to prescriptions in the beginning. It might be worth considering a pre-payment prescription plan. Please follow this link for more information: https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-prescription-prepayment-certificate-ppc
From 1st April 2023, women prescribed HRT will have access to a new scheme enabling access to a year’s worth of menopause prescription items for the cost of two single prescription charges (currently £18.70). As part of commitments to reduce the cost of HRT for menopausal women, the prescription prepayment certificate will be valid for 12 months. It can be used against a list of HRT prescription items, and a patient can use this against an unlimited number of HRT items, such as patches, tablets and topical preparations.
