Making sense of the menopause

Menopause and Hormone Replacement Treatment (HRT):

Natural menopause which usually occurs between the ages of 45 and 55, is due to the biological stage in every woman’s life, when the ovaries gradually run out of eggs, are unable to produce hormones (oestrogen and progesterone), and the periods stop. The time before the last period, when the estrogen levels are falling, is called the perimenopause. The low oestrogen level is responsible for symptoms such as hot flushes, night sweats, tiredness, joint and muscle ache, disturbed sleep, low mood, mood swings, forgetfulness or lack of concentration, vaginal dryness and loss of interest in sex. On longer term, it has consequences on vaginal, bladder, heart and bone health.

The severity, duration and impact of symptoms vary hugely between women. Physical and/or emotional symptoms affect up to 80% of women but in varying degrees. Symptoms can last from a few months to several years. The main reason to consider treatment is for symptom control (hot flushes and mood swings) and the most effective treatment is to replace oestrogen in the form of HRT. HRT can improve sexual desire and reduce vaginal dryness. It also helps to improve bone health and reduces the risk of osteoporosis and fractures in later life. The evidence also shows that, if women under 60 years old (called as window of opportunity) are started on HRT, it results in fewer cases of heart disease and fewer deaths.

HRT is recommended for women with troublesome menopausal symptoms, but is also recommended in women who experience a premature, (before age of 40) or early, (before age of 45) menopause, even if they do experience symptoms since HRT offers long term heart and bone health benefits.

The estrogen only HRT (used for women who have no uterus), is associated with lesser risk of breast cancer (four fewer cases), whereas there is a slight increased risk of breast cancer associated with estrogen and progesterone HRT (five extra cases over 7.5 years). This risk is higher the longer women stay on it and reduces when HRT is stopped. Risk of developing breast cancer also depends on underlying risk factors, such as body weight and drinking and smoking habits. HRT taken as a tablet increases risk of developing a blood clot, which is not the case if HRT is taken as a patch or gel. HRT in tablet form slightly increases risk of stroke, although the overall risk of stroke is very low in women under the age of 60 years.

The benefits and risks vary for each woman, and whether or not to take HRT is an individual choice. Many women have concerns about taking HRT after much publicity in recent years about risks, but the current view is that for most women, the benefits outweigh the small risks. Women are advised to maintain a balanced diet, engage in regular physical activity and refrain from smoking as these lifestyle factors play an important role in a woman’s short and long-term health.

Miss Joystna Pundir holds regular clinics at Nuffield Health Tunbridge Wells Hospital, if you’d like to arrange an appointment with her or for more information please contact us on 01892 888199 or visit

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