Advertisement

Meg Mathews: Everything you ever wanted to know about HRT but were too afraid to ask

Meg Mathews - Debbi Clark
Meg Mathews - Debbi Clark

Since 2018, Meg Mathews has been one of the UK’s foremost menopause campaigners, determined to use her profile to end the stigma surrounding it. In a new column for Stella magazine, she reveals what she’s learnt. This week: everything you need to know about HRT.

I’ve been taking HRT (hormone replacement therapy) for five years and it has helped me greatly on my menopause journey. I started taking it when I was 49 – I wish I’d started taking it at 45 because of all of the benefits it has brought me. HRT can ease menopause symptoms, from hot flushes to low mood and vaginal dryness – as I’ve written about in my previous columns, it has helped me overcome brain fog, low libido and weight gain. It can be taken as a tablet but in the past I've used a gel, which you rub on your thigh. I did try the patches but found they didn’t stick well to me and would get attached to my dog’s tail when he brushed past me! I now use a spray because it absorbs quickly, meaning no sticky feeling.

In the UK, most women go through the menopause between the ages of 45 and 55, with the average age being 51 years. Around half of all women will experience some physical or emotional symptoms – so understanding treatment is essential. Today, I’m answering common questions about HRT, with guidance from my trusted specialist Dr Ornella Cappellari. I hope it will help you on your menopause journey.

What is HRT?

HRT is a way of replacing the hormone levels that fall with menopause. It helps balance out the roller coaster of hormones during the perimenopause and increase hormone levels when they are low post-menopause. Typically, your doctor will prescribe a version of oestrogen, in tandem with synthetic progesterone (progestogen) if you have a womb.

What are the benefits of HRT?

Short-term benefits are symptom relief, which can improve your quality of day-to-day life. HRT can reduce hot flushes, improve joint and muscle symptoms, lift mood, reduce anxiety and improve sexual desire. Some women say HRT makes them ‘feel themselves again’. Long-term benefits include maintaining bone density, preventing osteoporosis and reducing the risk of fractures. There is increased evidence that HRT can help to protect the bowels, lowering the risk of colon cancer, and the heart, lowering the risk of disease. There is also some evidence that it may protect against dementia.

What are the risks of HRT?

HRT tablets have been found to increase the risk of stroke and heart disease, but there is no increased risk with transdermal HRT. There is evidence that taking some types of HRT slightly increases the risk of breast cancer. As for women of all ages, it’s important to be breast aware – examine your breasts and always attend mammogram appointments when offered them!

Can HRT really cause cancer?

When I first heard about HRT, I just kept visualising the word cancer in a big bubble. I felt confused and a bit worried. I started investigating and it felt like everyone had an opinion. There is strong evidence that taking HRT increases the risk of breast, womb and ovarian cancers. However, this increase is only slight – in the UK, around 1,400 cases of cancer per year are thought to be preventable by minimising HRT use. A woman’s exact risk is dependent on the type of HRT being taken, how long it is taken for and how strong the dose is. As always, it’s best that you discuss this with your doctor and you can decide for yourself whether the benefits outweigh the risks.

What are the side effects of HRT?

These can vary between individuals and the medications used, but progestogen can give you premenstrual symptoms such as breast tenderness, mood swings and irregular bleeding. Oestrogen can make you feel nauseous. Testosterone side effects are rare but can be linked to excess facial hair and lowering your voice.

Does HRT affect libido?

Testosterone is known to increase libido but if you don’t feel any difference after six weeks it most likely won’t make any difference.

Can HRT cause weight gain?

No it won't. It balances hormones so if anything it helps you to control your weight.

What are the natural alternatives to HRT?

Nutrition and lifestyle choices such as restorative yoga, skin brushing and hot and cold showers can benefit adrenal health. Magnesium is important for stress response; it’s best absorbed through the skin using a magnesium chloride spray oil. I haven't drunk alcohol for years now but avoiding excessive drinking is a good idea. Milk thistle is a great supplement that can support liver function, while dandelion is another great tonic for both kidneys and liver, which will ultimately support your adrenal glands.

I still get periods – should I wait until they have stopped before starting HRT?

If you are still experiencing your periods you can take HRT. In fact, the perimenopause is the time before your periods stop completely and your hormones are still swinging from high to low. Often, women experience their worst symptoms during this time and really benefit from HRT.

I find it really hard to remember to take all my medications – do you have any tips?

I forget vitamins but I never forget HRT – you feel rubbish if you don’t take it. I’ve heard the Medisafe app is good if you forget – you input all your doses and times and it reminds you.

In conclusion...

HRT comes with some risks (as does any drug – even over-the-counter painkillers) but each case has to be treated individually, because every woman is different. A study published in the Lancet in 2019 found that overall the benefits of HRT outweigh the risks for most women. So before starting HRT everything needs to be taken into consideration, including quality of life. I hope that helps you to decide if HRT is for you. Do your research, speak to your doctor and see what option is best for you.

Ask a question

Follow our Stella Facebook page for the latest from Stella Magazine, and join the Telegraph Women Facebook group, a place to discuss our stories