Friday 30 September 2016

To HRT or not to HRT?

No need to suffer in silence with symptoms of the menopause, it's just a matter of finding the right treatment for you

Ailin Quinlan

Published 10/11/2015 | 02:30

Menopause - safe effective remedies are available.
Menopause - safe effective remedies are available.

Night sweats, anxiety, hot flushes, interrupted sleep, panic attacks, moodiness, irritability, forgetfulness, weight gain, depression - the list of symptoms that so faithfully accompanies the menopause goes on and on.

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Yet according to the latest research, many women are not being treated even though safe, effective remedies are available.

Up to 50pc of women going through the menopause experience symptoms such as hot flushes and night sweats - and many find that Hormone Replacement Therapy (HRT) is an effective treatment, according to doctors.

However the findings of a recent survey in Australia, carried out by Monash University in Melbourne, showed that only about 11pc of 1,500 women between the ages of 40 and 65 were availing of HRT.

This was partly, researchers discovered, because of uncertainty over what the options are and what is and is not safe, as well as a complete lack of understanding among women that for the most part, the symptoms can continue for more than five years.

So what is HRT, and is it safe?

Hormone Replacement Therapy is a medication containing female hormones to replace the ones the body no longer makes following the menopause.

And yes, it's safe, declares Dr Shirley McQuade, medical director of Dublin's Well Woman Centre.

"I'm very positive about HRT. There is a multitude of menopausal symptoms among women, and HRT works very well for the vast majority of them."

If you were to try to treat these symptoms individually, she points out, you'd end up with an entire medicine cabinet full of 'stuff'.

"You might take sleeping tablets for sleep disturbance, analgesia for the aches and pains, non-hormonal treatments for the hot flushes, anti-depressants for the depression and mood swings as well as medication for osteoporosis if you're deemed to be at risk of that."

That, she adds, all compares to taking just one medication which will control all these symptoms in one go - HRT.

So how does it work?

"Women get menopausal symptoms because of hormonal fluctuations. The ovarian function decreases, you are producing less oestrogen. The oestrogen drop is not steady - it fluctuates - and that's what causes most of the problems. HRT levels out this fluctuation. Although the underlying reduction in ovarian function continues, the HRT overrides it by producing oestrogen and masking symptoms by levelling out the fluctuation.

"We say that if you're under the age of 60 and have been on HRT for four or five years it is absolutely safe," says McQuade.

HRT, which comes in the form of tablets or patches, relieves many of the symptoms associated with altered temperature regulation.

Side effects of HRT include fluid retention, which can cause headaches, breast tenderness and bloating, as well as nausea, but they usually disappear within two to three months.

However there is the risk of more serious side-effects - HRT also increases the risk of blood clots in the legs or lungs; there is a higher risk of strokes in the first year of taking it and an increased risk of breast cancer, though this tends to be in women who have been on HRT for more than four years.

Overall, however, the science says the risk of serious side effects is low - for example, studies show, that in the 50-65 year age group, it's estimated that about 32 in every 1,000 women will develop breast cancer. For the average woman starting to experience menopausal symptoms around the age of 50, HRT will normally be required for two or three years, according to McQuade. After this, many will find that when they stop taking HRT their own hormone levels will have stabilised.

However like everything else in life, despite the fact that many women find it excellent, it's not always a 100pc-guaranteed troubleshooter, as one 54-year-old mother of four discovered.

Jacqueline started using HRT patches in April 2014.

"I had very bad hot flushes and night sweats, and also suffered from terrible anxiety," she says, adding that as a result of the anxiety, her sleep was regularly disrupted. "I'm not a worrier, but I have turned into a big one since the symptoms started in 2013."

She had read about HRT and was encouraged by research showing the risks were minimal.

"I started wearing the HRT patch and I found it worked really well.

"All the symptoms disappeared - the only thing was that I bled heavily; continuous bleeding, which happens with some people who use HRT.

"This didn't right itself so I was weaned off the patch in October 2014 and everything was fine for about six months - after which the symptoms returned."

In June 2015 the Kilkenny woman was put on HRT tablets. Once again the symptoms disappeared - but after about three months they started to return, albeit at a lower intensity.

"I am about to try a new patch and I have been put on a low dose daily progesterone tablet," she reports, adding that she believes it's important for women not to give up on the search for the treatment that suits their individual needs.

"I believe you have to keep trying, and I hope that eventually it will work for me."

For those open to it, there are natural remedies - a change in diet and lifestyle as well as supplementation, as advised by Dr Dilís Clare, the Galway GP and medical herbalist who advocates the benefits of a range of supplements including essential fatty acids for menopausal women - studies in 2009 and 2011 found that fish oils helped with symptoms.

Clare also recommends a special mineral cake for bone strength and preventing osteoporosis (the recipe is on her website) as well as a variety of herbs to support all the changes the body goes through during this difficult time.

"They calm the heart, strengthen the circulation, which helps with palpitation and hot flushes.

"They can also help with insomnia and relax the muscles, as well as helping with adrenal stress, which is when the adrenal gland can become exhausted from continued stress."

She bases her work "on empirical science or observation over thousands of years, of effect or absence of ill effect," says Clare, who says she was the original sceptic - but now gives free information lectures on managing menopause on her website (healthandherbs.ie.).

"Most of the scientific evidence available is for commercially successful herbs but the science that is there in the main supports traditional medicine use," she says, adding that women's bodies are extremely complex.

"The human body is like 25 orchestras in a stadium with a great conductor - but women have an extra five for the years between puberty and menopause. At puberty these extra five orchestras are being set up and at menopause they are bowing out, which means the 20 remaining orchestras have to realign while still playing, so there is much turbulence and upheaval. How smooth the transition is depends on the conductor and the vitality of the players."

Qualified nurse and midwife Áine Delaney has been treating the symptoms of menopause for some 20 years - with needles.

She says acupuncture helps with symptoms such as anxiety, insomnia, sleep disturbance, mood change and hot flushes.

Here's how it works: "The client lies down and I insert about 10 very fine, single use, sterile, disposable needles, in head, hands, arms, legs, and sometimes abdomen," Delaney explains.

"The needles are inserted into points on the energy channels in the body. They regulate the electrical system or energy flow 'qi' of the body - we're not quite sure how it works, but it's about rebalancing the body's energy, which helps with the symptoms.

"Generally patients will report a significant improvement in symptoms like hot flushes, anxiety levels and sleep patterns after about six treatments," says Delaney, who adds that women reporting disruptive menopause symptoms make up about 20pc of her patient cohort.

The improvement can last for up to six months, after which some patients may need a "top-up."

"Most people will experience an improvement, others may need some herbs in conjunction with the treatment. I find it very good - in fact I find acupuncture powerful for all conditions and I don't view the menopause as being any different."

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