Why HRT may have health benefits beyond menopause
After many years, books, documentaries and national campaigns from the likes of Davina McCall to educate women - and doctors – about the benefits of HRT, it appears the goalposts are moving again.
A new study published in the Alzheimer’s Research and Therapy suggests HRT may help prevent Alzheimer’s disease in millions of women at risk of developing the condition, which has prompted a ripple of excitement in the world of women’s health. Instead of simply being a go-to remedy for hot flashes, brain fog and joint pain, should HRT be used as a preventative health measure?
Dr Louise Newson, GP and renowned menopause specialist (newsonhealth.co.uk), believes there is a strong case for giving it to women earlier, certainly in perimenopause. “Just look at the way we give statins to help prevent people from having heart disease,” she says.
“If people have an increased risk of heart disease or raised blood pressure, we don’t wait for them to have a heart attack to treat them - we often prescribe them statins or blood pressure lowering medications. Why shouldn’t we do the same with women and oestrogen?
“When oestrogen levels are low - which they are in the menopause and perimenopause - ‘inflammageing’ occurs. This increased inflammation in the body increases future risk of diseases such as diabetes, osteoporosis, heart disease, Type 2 diabetes and dementia,” explains Dr Newson.
“There’s plenty of evidence that estradiol - a type of oestrogen - is a potent anti-inflammatory, improving our brain function, cardiac health and bone strength and thereby lowering the risk of getting these diseases.”
Instead of thinking of HRT as a replacement therapy, Dr Newson believes it should be considered a ‘hormone support treatment’ with the new, safer formulations enabling individual patients having access to it earlier as a preventative measure if they wish, rather than simply as a treatment only for menopause symptoms.
“In the past HRT was synthetic and made from horses’ urine and there were understandable worries about the risk of blood clotting,” she says. “But now we have the new body identical hormones derived from yam plants, which are similar to the hormones produced in our body and they’re a lot safer especially as they’re taken transdermally, through the skin, reducing the risk of clotting.”
Word of caution
While Newson might be keen for HRT to be considered a preventative health tool, other menopause experts are expressing caution, especially as the new Alzheimer’s study was small - tracking the brains of 1,906 women over 50 who carried the APOE4 gene (the strongest risk factor gene for developing dementia) - and only hinted at a link between HRT and cognitive benefits to the brain.
“While these are exciting times and it’s great we’re starting to think of HRT proactively, the Alzheimer’s study was just an observational study with a small number of women with a certain gene and we need bigger randomised controlled trials and stronger data before we start prescribing HRT as a preventative health measure for dementia, bone strength or heart health,” says Dr Naomi Potter, co-author of Menopausing with Davina McCall and founder of menopausecare.co.uk.
“The current NICE guidelines are that we shouldn’t use HRT for prevention alone and the benefits have to outweigh the risks. For example, while the risk of breast cancer is small, if you have relatives with breast cancer that might change your perception of risk. Everybody is different and every case has to be treated differently. It’s not a magic bullet for all.”
But Potter admits that the new research is prompting women to consider HRT earlier.
“Historically, menopause was diagnosed when your period stopped but now, we’re aware that symptoms develop up to a decade before periods end and that’s the time when hormonal turbulence begins and women should start looking for solutions,” says Dr Potter.
Taking HRT at this stage - in the early perimenopausal years of your 40s - can have untold benefits.
“If you’re 42 with no symptoms, at the moment we can’t just start women on HRT,” says Dr Philippa Kaye, GP and author of the bestselling The M Word.
“But if you start having symptoms, we know it can benefit your health. As well as reducing the risk of osteoporosis, there’s more evidence now it’s protective against dementia, macular degeneration, osteoarthritis, and it can help with maintaining muscle mass and strength.
“If you start HRT within 10 years of the menopause, before 60, there’s also evidence it might protect against cardiovascular disease. There are the unquantifiable benefits, too; if it helps you sleep better, you’re less tired and more likely to exercise which has long-term health benefits.”
But Dr Kaye is keen to add that, “there have been conflicting studies in the past about risks of HRT with regards to breast cancer or stroke risk, and we need more funding and research so we can get definitive answers on everything.”
For women already on HRT, Dr Kaye believes there should be no cut-off time for stopping it, provided the perceived benefits outweigh the risks. “The biggest risk factor as you age is breast cancer, so whether you should carry on with HRT should be considered on an individual, case-by-case basis,” she says.
For postmenopausal women struggling with vaginal dryness, itchiness, painful sex and recurring urinary tract infections and who have come off - or never started - HRT, there’s always vaginal oestrogen.
“It’s important to look at body and vaginal symptoms separately and vaginal oestrogen is something safe that can be used for your entire life,” says Dr Kaye.
For postmenopausal women who had no need for HRT and are now experiencing FOMO and wondering if they should take it, Dr Potter’s advice is straightforward: “If it ain't broke, don’t fix it as HRT does have potential side effects.”