Hormone Replacement Therapy
Since the symptoms of menopause occur as a result of a significant drop in oestrogen levels, it is not surprising that the most effective treatment for menopause is oestrogen replacement therapy, otherwise known as Hormone Replacement Therapy (HRT). Replacement oestrogens offer ‘top to toe’ benefits.
HRT is not ‘just one thing’ but is a range of preparations with a variety of delivery routes, for example tablets, patches or gels. It is important to assess every woman individually in terms of her unique needs and take account of her previous medical history, family history and lifestyle factors when making recommendations for treatment.
The most common oestrogen prescribed currently as HRT is 17ӄ-estradiol which is molecularly or ‘body’ identical to one of the three oestrogen forms that exist in women, naturally, which are estradiol, estrone and estriol.
17ӄ-estradiol is extracted from natural sources such as soybeans and yams and formulated into a HRT preparation. There has been some confusion regarding the terms ‘body-identical’ and ‘bio-identical’ with the latter generally referring to unlicensed, unregulated products that are custom-compounded. At Menopause Wellbeing, I prescribe regulated, licensed products in accordance with safe, evidence-based prescribing which is however ‘natural’ as detailed above. Further information regarding the British Menopause Society's stance on Bio-identical products is available.
HRT is suitable for the vast majority of women, although not all women choose to try it. There are occasions when HRT is not appropriate. However, there are many other aspects of lifestyle which can be modified in order to improve health and wellbeing around the menopause. Our backgrounds in General Practice has provided us with extensive experience of advising patients regarding such matters, including not only physical health but also mental health and wellbeing strategies. In addition, for some women, non-hormonal alternatives may be an option.
In addition, testosterone therapy may be available.
As NHS GPs, we also know only too well what pressures family doctors are under and time is a most precious commodity; as a consequence, the kind of care/service we want to provide is just not possible. Menopause care is a time for talking, listening, and understanding - by working together, I can develop a personalised plan for you.
HRT and experience of prescribing it
Dr Jane Wilkinson says "During my time as a GP, and having the privilege of treating women around the menopause, one of the most powerful and life changing treatments I have prescribed is HRT. It’s hard to convey the pleasure in seeing a woman again after she has had a 2-3 months of treatment and returns to tell you, "I feel like I’ve got my life back" or, "My husband wants to thanks you for giving him back his wife!" or "I’m feeling so much better. I can sleep, I’m much happier and I’m getting on with my children so much better too!". One lady actually thanked me for saving her relationship which had been at breaking point when she first came to see me."
Sadly, many GPs have lost confidence in prescribing HRT and women are not always getting accurate and up-to-date evidence-based advice regarding treatments, allowing them to make the best decision for them. The information given in the ‘popular press’ as well as medical media does not always reflect the evidence or provide a balanced view.