HRT? MHT? What to use? When to use it? How to use it?
A lot of people assume that – because I’m a Naturopath – I’m against MHT (which used to be called HRT). Overall, I’m not. (In fact, if the medical treatments and the evidence available now had been available when I went through the menopause transition, I would have used them.)
MHT= Menopausal Hormonal Treatment versus HRT= Hormone Replacement Therapy
I believe that the best response to menopause today is a combination of mainstream medicine AND complementary therapies, depending on the individual of course.
What I AM against is the indiscriminate and ill-informed use (and often over-use) of the wrong treatments. It’s a subject close to my heart as a naturopath and as a woman – as I wrote in this 2014 article on Menopausal Madness. This is an ongoing issue for many women, as overloaded mainstream medical practitioners try and apply inappropriate “disease” models to an inevitable physiological process.
Attending a recent professional Webinar has helped me clarify my approach to the vexed question of hormonal therapies for women in their 40s to 70s. (That’s a lot of folks – with a whole range of symptoms and issues!)
Menopause is NOT a disease
Menopause is an inevitable physiological transition process for all women. It’s not a “disease” that has a “cure”. The drugs that are on offer treat the symptoms of peri-menopause and menopause.
Menopause involves a change in multiple body systems – a transition that comes with a range of highly confronting physiological, emotional and mental symptoms including:
- Hot flushes
- Insomnia
- Urinary Incontinence
- Anxiety
- Depression
- Exhaustion
- Dry vagina
The range and intensity of symptoms vary widely – AND many of the more subtle symptoms – like depression, anxiety and insomnia – can show up years before the actual Menopause (the date you stopped having periods).
When to treat menopause symptoms with pharmaceutical medicines – and when to offer other forms of symptomatic support – is a complex question.
This Medscape article Menopause: When to Treat and When to Wait is an excellent guide to the symptoms, testing options and treatment decisions involved. A key point it makes is the very limited value of blood tests. Women’s hormones levels fluctuate from hour to hour and day to day – so any point-in-time blood test is unlikely to be meaningful.
Medical approaches to menopause have changed – and changed again and again – as the range of pharmaceutical options increased. What used to be called Hormone Replacement Therapy (HRT) is now more accurately called Menopausal Hormone Therapy (MHT).
Along with pharmaceutical medicines, there has been an increase in the number and availability of over-the-counter remedies with very varied sources and levels of effectiveness.
The result is that many women face a world of conflicting and contradictory information – and at a time when their ability to deal with complex and confusing issues is limited. As the “sandwich” generation, women who experience menopause today often face this disruption at a time when their work and family responsibilities are “at maximum”.
What do you do when you start wondering “is this menopause”?
If you think you could be in transition (and for most women, peri-menopause starts in their 40s) then it’s probably wise to include your own GP – as they know your medical history as well as a Naturopath. Broaden your understanding with views from mainstream as well as complementary medicine.
The first conversation to have with your practitioners of choice is about their 1) knowledge of 2) experience with and 3) interest in menopause and current available treatments. Not all GPs have the interest or the expertise to offer effective solutions. Naturopaths generally have a lot of experience in this area, especially if they are female and over 50 years old!
There are over 50 options now for pharmaceutical MHT. Each of them is a drug with benefits AND side effects. Some will work better than others for each individual, so there can be an ongoing process to find the right one.
Make sure your GP is current with today’s range of treatments AND understand the risks and benefits and can communicate the options and their risks and benefits clearly.
If you need to look further than your GP and you live in Melbourne, you could contact the Jean Hailes Foundation in Melbourne for a referral to someone in their clinic.
The are also many specialist GPs in Melbourne able to offer online Consultations – and I keep a list to help my patients. One specialist practice I know and recommend is the team at Real Life Medicine
Menopausal and peri-menopausal symptoms vary
Pharmaceutical medicines are known to help with:
- Vasomotor System – which produces symptoms such as hot flushes, anxiety,
- GenitoUrinary System – which produces symptoms ranging from dryness to incontinence.
- Skeletal System – where changes can lead to reduced bone density.
- Mental Health – like anxiety and depression
There is not significant evidence yet supporting claims that MHT is useful for helping hair loss. Current thinking is that hair loss is to do mainly with the stress response – and that the stress should be treated.
The form of delivery for pharmaceuticals matters
A. For oestrogens or estridiol, options are:
- oral tablets eg. Femoston
- Transdermal (through the skin) patches or gels eg. Sandrena
- Vaginally with creams, tablets or pessaries eg. Ovestin
As I’ve mentioned, there are over 50 options now for pharmaceutical MHT, listed on the website of the Australian Menpause Society. Finding “the right treatment” is a complicated field, one that no blog post can explain the detail. To give you an idea of the complexities…
Some oral estradiols have cardiovascular risks in certain groups of women – it’s now thought that they may increase LDL and triglyceride levels but decrease HDL, along with increased coagulation risk and the inflammatory marker CRP. This is particularly an issue for smokers, those with migraine and obesity.
Transdermal gels or patches – applied to your skin – can reduce these unwanted side-effects. There are no adverse effects on your liver. A steadier state of hormone release happens this way.
Vaginal estradiol is generally well tolerated with very low risk. This is often used as a first line therapy for GSM (genito-urinary symptoms of menopause), eg dry vagina, urinary incontinence. This therapy does NOT require progesterone for endometrial protection, whereas the other estradiols do (if you have a uterus).
If you have a uterus you need to take progesterone as well as estradiol – in order to reduce cancer risk for endometrium – so micronized progesterone is considered helpful. The different types of Progestogens will be covered in my next blog.
Plant-based sources of estrogen are increasingly used in the manufacture of Menopause Hormone Therapy (MHT). These are generally derived from plant steroids, most commonly wild yams (Dioscorea family) and soybeans (Glycine max). These plants provide compounds like diosgenin (from yams) and isoflavones/genistein (from soy) that are converted in pharmaceutical laboratories into estradiol and progesterone
“It’s complicated” – however today there are a growing range of good information sources and studies. One good source is the Australian Menopause Society.
It’s your body – so a bit of time invested in understanding the options is well worth while. If you’re overwhelmed, then enlist support from an experienced practitioner. (I offer online consultations as well as face-to-face sessions – so get in touch if you need guidance and a sympathetic guide.)
Pharmaceuticals AND complementary treatments are giving excellent results
I can help you from a Naturopathic perspective – with complementary treatments that also mitgate symptoms alongside the use of MHT. I write about them regularly – so check out my resource page on Women’s Health and Menopause
As with any issue with your mental and physical health – food, exercise, and life style changes may be required specific to your life stage – in addition to both mainstream and naturopathic treatments.
I see a number of patients who have used MHT for a while and get some benefit – who then feel even better when they use appropriate Naturopathic approaches as well.
We’re all individuals, and our bodies and lives need appropriate, customised treatments. Some people need more support with symptoms like anxiety or depression or overwhelm. Others need more help with osteoporosis or heart disease or diabetes.
Menopause is a complex physiological process that typically takes place over a decade (or more). Toughing it out, soldiering on, or assuming that the average GP is all you need to get “a quick prescription” is likely to leave you stressed, anxious and exhausted.
The right treatments, in the right delivery mode, with the right support and life style changes can make a world of difference.
Get expert help on this physiological shift – and get in touch if you need guidance or support.
