Managing Menopause - HRT
In the world of women's health, there comes a time when everything seems to change.
It can be that unusual feeling of despair, the constant forgetfulness, and those irregular periods that suddenly disrupt your life. Meet Sally, an Australian woman in her mid-40s. Just three years ago, she was a regular at her Pilates classes, attending four times a week. Now, she can barely muster the energy to exercise, all thanks to chronic insomnia. Her friendly demeanour has shifted to constant anxiety, affecting both her work and home life.
Uncertain about what was happening to her body, Sally decided to visit her doctor. The physician's diagnosis? Stress, the classic culprit. He suggested Sally return in a year, leaving her feeling frustrated and unheard. In search of answers, Sally turned to the ever-resourceful Dr. Google. Her research pointed her towards the onset of perimenopause.
What is Menopause?
Menopause is the final menstrual period in a woman’s life, typically occurring between the ages of 45 and 55 years, with the average age of onset at around 50 years. When a woman has had no periods for 12 consecutive months, she is considered "postmenopausal."
However, before reaching this stage, women go through perimenopause which is the onset of new menopausal symptoms (such as irregular periods, hot flushes, night sweats, or sleep disturbances) and a change in the pattern of menstrual bleeding. It can last on average 4 to 8 years. One year after the last menstrual period the woman is considered "postmenopausal".
Sally's experience is unremarkable in two ways: every woman experiences menopause, and doctors may not always recognise it or provide treatment that alleviates symptoms. Research suggests close to 80% of women experience symptoms, and for 20% of them, these symptoms are debilitating. On average, they last for four to eight years.
Despite the prevalence of these symptoms, some clinicians worldwide still have a dismissive attitude toward menopause. Some only recommend lifestyle changes like eating well and exercising more, while others prescribe anti-depressants or anti-epileptics. While these solutions may ease symptoms, they often fail to address the underlying problem. An effective option of care for menopausal symptoms exists: Hormone Replacement Therapy (HRT).
The Great Hormone Scare
In 1997, a landmark report in the Journal of American Medical Association concluded that HRT extended postmenopausal women's life expectancy by up to three years. But then, a bombshell dropped.
In 2002, the rushed release of the Women's Health Initiative (WHI) study by the US National Institutes of Health declared that combining estrogen and synthetic progesterone heightened the risks of breast cancer, heart attacks, strokes, and blood clots, overshadowing the benefits of HRT.
This finding overturned decades of medical practice. To make matters worse, a scandal about financial ties to pharmaceutical companies emerged, tarnishing HRT's image from a wonder-drug to a profit-driven peril.
But here's the thing: The WHI study's initial conclusions were flawed. It’s recruitment included older, less healthy participants who didn't accurately represent menopausal women. The exclusion of women with menopausal symptoms skewed results, sidelining those most likely to benefit. The abrupt conclusion to the study, coupled with the way results were presented, failed to contextualise the risks associated with HRT, minimising its benefits.
The Benefits of HRT
The benefits of HRT are clear. In the short term, it offers relief from the persistent symptoms of menopause. Over time, it reduces the risk of osteoporosis, which rises after menopause, and therefore the risk of bone fractures. Most significantly, studies suggest that HRT can help to prevent cardiovascular disease – a major cause of women's mortality.
Of course, hormonal therapies are not appropriate for all menopausal women. For some, their symptoms aren't impactful enough for it to be worthwhile. Others may have liver disease, a history of blood clots, or breast cancer, making it not worth the risk.
Sally's Journey to Relief
Sally's symptoms worsened over the year. Her online research and a curious Instagram algorithm convinced her that she was transitioning into menopause. Determined to find answers, she decided to get her blood tested. The results confirmed her suspicions - her hormones were imbalanced.
With the diagnosis in hand, Sally's doctor prescribed her personalised hormone therapy, consisting of estrogen and progesterone. Within a few weeks, her hot flushes had significantly reduced, she was sleeping like a baby, and her mood was cheery again. She couldn't believe she had endured her symptoms for so long. She felt "superhuman."
But her happy ending is less common than it should be. And that's why Women's Health Road is creating a new standard in women's health.
A Conversation Worth Having
Of course, this article isn't advocating for menopausal hormone therapy for all women because every woman's health conditions, risk analysis, and profile are different. Rather, this article sheds light on the fact that women should have the right to feel that there is time and space for a conversation about how to manage their symptoms and improve their quality of life. They should be able to access evidence-based information about available menopause management options.
By sharing Sally's story and debunking myths surrounding HRT, we hope to empower women to make informed decisions about their health. It's time to break the silence, start conversations, and ensure that every woman's journey through menopause is as smooth and comfortable as possible.
