9. When to consider Menopausal Hormone Therapy (MHT)?

Different language for a new understanding of using hormones during this big time of physical and mental transition into a new state.

HRT - Hormone replacement therapy is taking hormones to replace the hormones that have now become deficient in the body. The thought pattern is that we can replace missing or depleting hormones.

MHT - Menopause Hormone therapy is a therapy to help women manage the menopause transition in particular the many symptoms, especially vasomotor symptoms that can happen during this time. The thought pattern is that this is an intervention to address the withdrawal from depleted hormones in our system.

Potential Benefits of MHT include:

• MHT is the most effective treatment for hot flashes and night sweats.

• MHT may help with vaginal dryness, mood changes and sleep.

• There is some efficacy for preserving bone mass, & using it for the prevention of bone loss, but it is not a treatment.

• MHT may help with the attenuating fat mass gain in recreational active women with less than 27% body fat. Although , important to note is that intense exercise has a greater effect.

• MHT is not effective for building lean mass due to the change in estrogen receptors within the myosin filament of the muscle itself.

Different types of MHT are associated with different risks and the risks vary according to;

• Age

• Age at the onset of menopause

• Hysterectomy status (including or not the ovaries)

• Pre-existing conditions

Potential Risks include:

• Blood clots in the legs and lungs with the pill form of treatment. (This is significantly decreased with the patch form).

• IF you start using treatment older than 60 it can increase the risk of alzheimers and dementia.

• Breast cancer can be a risk but it is small, however the longer a woman uses MHT the more her risk increases.

• Estrogen only MHT decreases the risk of breast cancer.

• Stroke risk factors are minimally increased with the use of patch or the gel form of treatment.

• If there is a family history of deep vein thrombosis or stroke then do not take the pill but use the patch or gel.

When to consider MHT?

• If it is taken for the correct reasons such as to alleviate symptoms of vasomotor and genitourinary issues.

• If it is only taken for as long as necessary at the lowest effective dose and the dose is delivered in accordance to your risk factors determined in consultation with your GP or endocrinologist.

• You can consider using it if your symptoms are interfering with how you feel daily and have started within 10 years of the onset of perimenopause, and before the age of 60. After the age of 60 the risk increases and one should consider that maybe the risks outweigh the benefits.

  • The risk stratification by age occurs based on the time since menopause, so the absolute age of saying 60 is a generalised set point. If you did not hit perimenopause until you were 55, and you hit actual menopause at 60, then it is still considered beneficial but you do have to talk to your GP

• Users should reassess on a yearly basis.