All you need to know about HRT

Hot days can mark the end of summer, the end of a fertile season in which flowers have burst into glorious colour and plants have shot up in height; hot flushes signal the end of a woman’s fertile “summer” in which she has had children (perhaps) and watched them grow.

The Victorian author Samuel Butler describes how “autumn is the mellower season, and what we lose in flowers, we more than gain in fruits”. During a woman’s “autumn” (post menopause) she can also enjoy the fruits of her labour, before entering the “winter” of old age.

According to Professor Henry Burger, fellow of the Australian Academy of Health, going through “the change” (as the menopause is frequently called) can trigger “hot flushes (or flashes if you’re American), cold sweats, spells of vertigo, depression, headaches, insomnia, palpitations, lack of energy, diarrhoea and/or constipation, persistent cough, backaches, upset stomach, aches or stiffness in joints, shortness of breath, sore throat, loss of appetite, menstrual problems, fluid retention, difficulty concentrating, nervous tension, urinary tract or bladder infections, pins-and-needles sensations and decreased libido”.

More long term, menopause may be linked to increased risk of heart attack (it’s well known that there is a striking increase in heart attacks in women after the menopause) and loss of bone strength, resulting in increased fracture risk.

During menopause, a woman’s ovaries effectively stop producing oestrogen and progesterone, and this leads to the troublesome symptoms. HRT works to replace oestrogen (usually combined with progesterone). It can be taken in tablet form or via skin patches, gels, implants or as a vaginal pessary. Side effects can include headaches, nausea and weight gain, but switching to another type of HRT usually helps.

Carol Vorderman has revealed how HRT saved her from crippling depression; thousands of women have found relief from the various symptoms of menopause with HRT. It can also strengthen bones and reduce risk of colon cancer. Earlier studies suggested that it might reduce heart attack risk and even improve memory (though this is now disputed).

To everything there is a season. Opinion remains strongly divided as to how long that season should be.

Some doctors recommend taking the smallest dose for the shortest possible time to reduce menopausal symptoms, but stopping at the earliest opportunity because HRT may increase breast cancer and blood clot risk.

Others see HRT as an appropriate drug to take for the longer term, reasoning that factors such as being overweight, drinking wine, having an early first period or a late menopause or childlessness also confer a risk of breast cancer, but that benefits of HRT can outweigh its risks in some people. Ellen is one such young woman: diagnosed with agonising endometriosis in her late teens, she now takes HRT for the long term to counteract the effects of Zoladex, a drug which has stopped the pain and “given her life back again”.

In fact, HRT may be less risky in some women than others: Dr Ningqi Hou from the University of Chicago has written that “black women, obese women and women with breast tissue composed largely of fat may benefit from HRT use with minimal excess breast cancer risk”.

Countries near to the equator have virtually no seasons. For some women, there is no season during which it is appropriate to take HRT. This includes women with a strong family history of breast cancer or women who have already had a heart attack (paradoxically, HRT has been shown to increase heart attack risk in such women) or blood clot.

According to some rather puzzling Hungarian research, “the changing of seasons may have a major impact on the start of menopause” with higher rates observed after the spring and autumn equinoxes. Whether this is really true, and why it should occur, is unknown.

That the human body can go through seasons just like the natural world is a thought that Leonardo da Vinci would have endorsed. He viewed the human body as a “little world” that reflected the structure of the world as a whole: he compared water currents in rivers and the seas with the flowing of blood in the arteries and veins.

Albert Einstein said “look deep into nature and then you will understand everything better”. It certainly helps when thinking through the menopause and HRT.

Helen Cowan completed a PhD in cardiac pharmacology at Oxford in 2002. She is a qualified nurse and has written for the British Journal of Cardiac Nursing, and worked as a columnist in the Nursing Times. Read more from Helen here.