Question 1. 

I am in my late 40s and having some symptoms that may be related to menopause-do I need a blood test?

Answer: No! In the perimenopause blood tests can be normal as they fluctuate daily.Only younger women (<45) need hormone levels checked to confirm the diagnosis.Occasionally estradiol levels may be checked to monitor response to treatment but these are often unhelpful/inaccurate.

Question 2. 

My mother had breast cancer in her 60s so does this mean I can't take HRT?
Answer: No.Most breast cancers are not genetic and the increased risk with HRT is very  small.However if you have a strong family history of breast cancer and deemed high risk it is best to avoid HRT.

Question 3.

Does HRT cause weight gain?
Answer:There is no evidence HRT causes weight gain.Women tend to gain weight and have change in body shape with increased abdominal fat around the time of the menopause and HRT may actually help reduce this.

Question 4.

Does taking HRT just delay the symptoms and will I have to suffer eventually when I stop HRT?
Answer: No-HRT relieves the symptoms.The majority of women will be able to successfully discontinue treatment after a few years but some unlucky women will continue to have symptoms for many years and need long term if not lifelong HRT.There is no arbitrary time limit for HRT use.

Question 5.

I am perimenopausal do I still need contraception?
Answer:Yes! You need to use contraception for 2 years after last period if this happens below age 50 or for 1 year if last period is over age 50.The Mirena intrauterine system can be very useful as it minimises bleeding problems and provides the hormone progesterone so you can have oestrogen only HRT if needed.Other hormonal methods of contraception can be used with HRT.
HRT is not contraceptive!

Question 6.

I am having bleeding problems on HRT should I be concerned?
If you have been on ‘no bleed HRT for less than 6 months bleeding is very common and usually settles.If you have been bleed free for more than 6 months on HRT and start bleeding please see your GP for an urgent referral for gynaecological assessment or book an appointment with one of my gynaecology colleagues in Kingsbridge.If you are on a separate progestogen eg Utrogestan it is important you take the correct dose as prescribed to protect the lining of your womb. Bleeding is very common when using Utrogestan as the progestogen part of HRT and you may need to switch to a different regime or consider the Mirena intrauterine system.

Question 7.

Can you prescribe bio-identical HRT?
Bio-identical HRT is unregulated,unlicensed and not necessarily better or safer than conventional prescribable HRT .However body identical HRT is commonly used and available on NHS prescription from your GP.It is usually in the form of an oestrogen patch or gel with separate Utrogestan, a natural progesterone.There is now a combined  body identical tablet Bijuve,also available on the NHS.
There is limited data suggesting body identical HRT may have lower risks than preparations with  synthetic progestogens.More research is required and in practice bleeding problems are common.
Please see this fact sheet for more information

Question 8.

What is testosterone?
Testosterone is a hormone produced by ovaries and the adrenal glands.Levels fall gradually in women long before menopause but often remain the normal range and in fact increase again in 60/70s.It is not an essential part of HRT but can be used for loss of libido in postmenopausal women once oestrogen replacement is optimised.Some women find it helpful but loss of libido is common and often multifactorial.The women who benefit most are usually younger women who have had a surgical menopause.It is not recommended for energy/mood/brain fog as there is no evidence it is of benefit.There is no licensed preparation available in the UK so a gel that is licensed for men is prescribed off-licence at a lower dose.Testosterone is also converted into oestrogen in the body so not safe for those with a history of oestrogen dependent cancers.
It is recommended  that testosterone levels are monitored if continuing treatment to ensure levels stay within the normal female range. Testosterone should not be used in the perimenopause.
Not all GPs are happy to prescribe testosterone but many will prescribe if given specialist advice.

Question 9.

I have had breast cancer can I take HRT?
HRT is best avoided if you have a history of breast cancer whether oestrogen dependent or not.However some women do decide to accept a possible increased risk of recurrence or new cancer if symptoms are severe.This should be after discussion with oncologist and menopause specialist.Please see Women's Health Concern website for further information on alternatives to HRT.

Question 10.
Should all women take HRT?
Absolutely not unless experiencing early menopause or troublesome symptoms.Menopause is a normal part of life and long term HRT over the age of 50 is not essential for health.There has been significant media hype worrying women who aren't on HRT and have no symptoms.It is not recommended over 50 for protection against heart disease or dementia.