Menopause is a stage in the life of every woman. Beginning in her 40s or 50s, it is marked by the end of her menstrual cycles. The average age in the US is 51.

Strictly speaking, a doctor diagnoses it when she has gone 12 months without a period. As the chart shows, it is caused by a reduction in the production of estrogen by the ovaries.

It is a natural biological process. But the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt your sleep, lower your energy or affect emotional health. The chart here depicts symptoms and conditions associated with the change.

Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. There are many effective treatments available, from lifestyle adjustments to hormone therapy.

Today I want to discuss hormone replacement therapy.

What is hormone replacement therapy?

In simplest terms it is the treatment, not of menopause, but of the symptoms of menopause, caused by dropping estrogen levels. For treatments that are systemic, taken orally or transdermally (that is, a skin patch), they consist of three kinds: estrogen only, a combination of estrogen and progesterone, and, rarely, progesterone only. For treatment of some “local” symptoms, such as vaginal drying, discomfort during intercourse, and some urinary symptoms, a vaginal cream containing estrogen can be effective.

What are the benefits of HRT?

If the dosing is appropriate then the “vasomotor symptoms,” hot flashes and night sweats, will be under control. In addition, because menopause leads to increased cardiovascular disease risk and to bone loss or osteoporosis, treatment can prevent or delay these important diseases and conditions.

What are the risks of HRT?

Unfortunately there is a real increase in the incidence of breast cancer. There have been extensive studies but the most definitive was published in September 2019 by a group from the University of Oxford in England. They found four important findings:

• The later in life a woman started HRT the lower her risk of getting future cancer. Starting before age 50 was much worse than starting after age 60.
• HRT preparations that had both estrogen-progesterone caused breast cancer significantly more frequently than estrogen preparations alone. Vaginal estrogen was effective for local symptoms and importantly did not increase the risk of breast cancer at all, probably because it didn’t produce much systemic absorption.
• The longer a woman took HRT the greater her incidence of breast cancer. So 5 years of therapy was significantly worse than 10 years of treatment. Importantly, treatment of less than one year was NOT associated with an increased risk of breast cancer.
• Higher body-mass index (BMI) was associated with an increased risk of breast cancer without HRT and the effects of HRT was to raise the cancer risk in women with low BMI to the same level as women with high BMI.

Are there any natural options to HRT?

Yes! You can reduce the frequency and/or severity of the hot flashes, night sweats, and other symptoms. Here are a few ideas:

Do regular exercise

Regular physical activity can reduce hot flashes and improve sleep. It’s also a good way of boosting your mood if you feel anxious, irritable or depressed. Weight-bearing exercises can help keep your bones strong

Have a healthy diet

A balanced diet can help ensure you do not put on weight and can keep your bones healthy

Stay cool at night

Wear loose clothes and sleep in a cool, well-ventilated room if you experience hot flushes and night sweats

Cut down on caffeine,

alcohol and spicy food, as they have all been known to trigger hot flashes

Try to reduce stress levels

to improve mood swings, make sure you get plenty of rest, as well as getting regular exercise. Activities such as yoga and tai chi may help you relax

Give up smoking

if you smoke – giving up will help reduce hot flushes and your risk of developing serious health conditions, such as heart disease, stroke and cancer

Try vaginal lubricant or moisturiser

if you experience vaginal dryness – several different types are available to buy from shops and pharmacies

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And the wrap is…

• Menopause is a normal, natural phase of life that all women will go through.
• The symptoms can be reduced by cutting caffeine as well as other lifestyle symptoms. Try these first.
• If, after lifestyle changes, you still need help consider HRT with your doctor. Here focus on estrogen only preparations. And try one year of therapy and then take a ‘treatment holiday.’