When is Hormone Therapy Not Recommended For Menopause?

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Hormone replacement therapy is prescribed to women with menopause to help ease their symptoms. During menopause oestrogen and progesterone levels fluctuate which can lead to unwanted symptoms of menopause. Medications containing hormones can help stabilise oestrogen and progesterone levels. Most hormone replacement therapies consist of oestrogen. Each individual will have a different menopausal experience, some women might have severe symptoms and others might not. 

Hormone replacement therapy is not recommended for everyone and can have severe complications. It is important to first speak to a medical professional before starting hormone replacement therapy. 


What is Hormone Replacement Therapy?

Hormone replacement therapy (HRT) is a medication that consists of female hormones. Women tend to take HRT during menopause to help with menopausal symptoms due to fluctuations of the female hormones, oestrogen, and progesterone. Hormone replacement therapy normally helps with symptoms such as hot flushes, night sweats and mood swings. There are also benefits to taking HRT such as the prevention of developing osteoporosis for post-menopausal women. Like any other medication, there are risks in taking hormone replacement therapy. These risks depend on the duration of therapy and the type of hormone replacement therapy. Hormone replacement therapy should be tailored to each specific individual to ensure the best results.


Basic Types of Hormone Therapy

Hormone replacement therapy mostly focuses on replacing the hormone oestrogen to prevent fluctuation of this hormone. Women going through menopause no longer have high levels of oestrogen due to decreased production by the ovaries. 

Oestrogen Therapy

The most suitable Hormone Replacement Therapy (HRT) for you is contingent upon various factors, such as whether you've undergone a hysterectomy, the specific stage of menopause you're experiencing, and your individual preferences

Systemic Hormone Therapy

This is oestrogen in a tablet, skin patch, gel, spray, or cream. These medications contain oestrogen that is absorbed by the body. It is used to treat menopausal symptoms such as hot flushes, night sweats and mood swings.

Low-dose Vaginal Products

Low-dose of vaginal preparations comes in a dosage form of a cream, tablet, or a vaginal ring. These products are normally used to treat vaginal dryness.

If a woman has not had a hysterectomy (removal of the uterus) before then a doctor will prescribe progesterone alongside oestrogen. Oestrogen alone can stimulate the growth of the uterus lining when not balanced with progesterone. Stimulating growth of the uterus lining can increase the risk of endometrial cancer. 


Risks of Hormone Replacement Therapy

Research indicated that taking hormone replacement therapy consisting of oestrogen and progesterone can increase the risk of developing heart disease, stroke, blood clots and breast cancer. These risks differ depending on:

  • Age – women who start with HRT 10 years after the onset of menopause have a greater risk of developing heart disease, stroke, blood clots and breast cancer. If HRT is started before 10 years of onset of menopause, then the benefits outweigh the risks.
  • Type of Hormone Therapy – the risk of hormone therapy differs depending on the dose of oestrogen and whether it is given in combination with progesterone.
  • Health History – Family history and risk of developing cancer play a big role when it comes to HRT. 

Women need to see a medical doctor before starting with HRT so that all factors can be considered before initiating therapy. 


Hormone Replacement Therapy and Cancer

Women who have a family history of breast cancer are advised not to take HRT. Oestrogen in HRT can trigger cancer, especially breast cancer to start or come back. More research is being conducted on this topic, the risk of taking HRT with a risk of developing breast cancer is not yet fully understood. Women who are high-risk patients for developing breast cancer while on HRT must visit their medical doctors regularly for follow-up appointments. Women with uterine cancer of a family history of uterine cancer are also not advised to take HRT. This can also increase the chances for the cancer to start or to come back. 


Hormone Replacement Therapy and Smoking

Not only does smoking while taking HRT increase the risk for blood clot formation and cardiovascular diseases for menopausal women. Depending on the dose of nicotine consumption, smoking can reduce or completely diminish oestrogen to help with menopausal symptoms. It can also prevent the positive effects of oestrogen such as decreasing the chances of developing osteoporosis post-menopausal. The decrease in therapeutic efficiency is due to dose-dependent elevated hepatic clearance, partially in combination of with lower oestrogen levels. Increasing the HRT dose is not an option for smokers, as this can cause the development of toxic oestrogen metabolites. The better option of HRT for smokers is the use of transdermal patches, which release the hormones through the skin where is it absorbed into the body. 


HRT, Blood Clots and Stroke

Hormone replacement therapy can increase the chances of developing blood clots. It is safer for women who have a high risk of developing a blood clot to use transdermal patches, sprays, or gels. These medications are absorbed through the skin and are safer to use for such individuals. Using hormone replacement therapy in tablet formation can increase the chances of forming a blood clot. The formation of a blood clot increases the risk of stroke. Hormone replacement therapy in tablet formation increases the chances of developing stroke. Individuals with a risk of developing a stroke are encouraged to use transdermal patches, sprays and gels rather than tablets.


Alternatives to HRT

Women have found the following tips useful to help with menopausal symptoms if HRT is not recommended for them.


To Decrease Sleeping Problems

Exercise and being active can reduce stress and promote better sleep. Relaxing techniques such as meditation or light stretching before bed can promote sleep. Drinking chamomile tea before bed can also help decrease sleeping problems.


Hot Flushes

Being active and exercising can help to decrease hot flushes. It is advised to wear light and cool clothing.


Relieve Vaginal Dryness

Use silicone-based lubricant during sexual activities. Women can speak to their doctor about creams to improve vaginal dryness.

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