The truth about hormone therapy

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It’s 6pm and, after powering through a brisk walk and evening shower, Penny Johnson is slathering a special clear gel on her skin. But this is no anti-ageing serum infused with mineral peptides, probiotics or green tea. It contains 1.25mg of oestrogen per dose, measured out in one ‘pump’, to relieve her menopausal symptoms. Every day, Penny, a 56-year-old Sydney primary school teacher, rubs the gel along her upper arm, alternating with the other arm the next night. “After only two months, my energy levels and sleep have really improved and my skin, eyes and vagina are no longer super dry,” she explains. “My anxiety is far less and I’m not getting recurring bladder infections, so that’s been a huge relief.”

In trying hormone treatment for menopausal blahs, Penny is in a small minority. Most women give MHT (menopausal hormone therapy, formerly hormone replacement therapy, or HRT) a big miss in any form. According to Australian research, only 13 per cent of Aussie women in their 50s take MHT. Yet many do a daily dance with menopausal symptoms ranging from hot flushes, night sweats, vaginal dryness and weight gain to dry, itchy skin, low libido, brain fog, anxiety and mood swings. “Though 20 per cent of women have no symptoms around menopause, 80 per cent experience symptoms and 20 per cent have symptoms that go on for more than five years,” says Dr Sonia Davison, president of the Australasian Menopause Society.

RIDING THE HORMONE ROLLER-COASTER 

Rusty on your menopause basics? Here’s a quick refresher. As you hit your 40s, hormone levels can start to fluctuate, kick-starting perimenopause, which is sometimes signposted by menstrual changes. Oestrogen levels may start to rise and fall like a big dipper, triggering hot flushes, which may ramp up closer to your very last period, which heralds menopause, often around age 51. 

Enter MHT, which can be a woman’s best friend. First sold in the 1930s in injectable form, by the 60s, MHT pills sat alongside lipsticks and compacts on the bathroom shelves of many menopausal women. Over the decades, new and improved options appeared. Cut to the present and MHT is available in many different options, including gels, capsules, nasal sprays, an IUD, vaginal pessaries/creams and patches of oestrogen alone or combined oestrogen/progestogen (the synthetic form of progesterone). “As well as being the most effective treatment for menopausal symptoms, MHT can be beneficial for a woman’s bone health and cardiovascular function,” says Dr Davison. “Some studies have shown different forms of MHT can reduce the risk of developing type 2 diabetes and colorectal cancer.” That’s an impressive roll call of benefits, so why are women with menopausal issues still soldiering on without MHT?

MISGUIDED SAFETY FEARS 

MHT took a big blow to its reputation in 2002, when the US Women’s Health Initiative Study (WHI) found a higher breast cancer risk in women taking both oestrogen and progestogen pills for more than five years. As headlines screamed ‘MHT causes breast cancer’, women all over the world panicked and binned their pills, patches and pessaries. But the results were blown out of proportion. According to Dr Jen Gunter, in her book, The Menopause Manifesto, in real terms the study actually found that “six additional women developed breast cancer a year for every 10,000 who took MHT, which is slightly less than 0.1 per cent of women on MHT a year.” Since then, studies have shown that taking MHT earlier may boost longevity. “Women using MHT between the ages of 50 and 59 have a 30 per cent lower risk of dying versus women given a placebo,” Dr Gunter points out.

Regardless, the hype still holds sway. “From 2002, the number of women taking MHT dramatically dropped, as women needlessly PHOTOGRAPHY: GETTY IMAGES FEBRUARY 2022 PREVENTION 101 MHT UNVEILED abandoned a treatment that offered them enormous and important relief from menopause symptoms,” says Dr Davison. What women weren’t told? That the 2002 WHI study was designed to check if MHT protects against heart disease, so it included mostly women in their 60s and 70s and half were smokers or ex-smokers. 

“This meant that this group of women already had a higher risk of breast cancer, due to their age and other lifestyle factors,” Dr Davison explains. The study also used only one type of oestrogen and one type of progestogen, both in tablet form. “Based on just one form of MHT, the research findings can’t be applied to other more current types and delivery methods, such as patches or patches combined with pills,” Dr Davison says. Ditto for research involving Oxford University, which was published in medical journal The Lancet in 2019. 

“Now when a woman uses combined MHT, we often prescribe an oestrogen patch and a newer form of micronised progestogen, which is closer to natural progesterone,” says Professor Jayashri Kulkarni, a leading women’s health and hormone expert and director of Monash Alfred Psychiatry Research Centre in Melbourne. This safer combo doesn’t increase breast cancer risk within five years of use, the Lancet study found. And for women taking oestrogen-only MHT for seven years, it actually lowered their risk of breast cancer, the 2002 WHI study discovered. Yet these good news stories have barely been reported.

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