A Guide to the Menopause and HRT: Understanding Your Options for Wellbeing

Dr Stephanie Goodwin is a GP and a leading hormones expert with the menopause as a speciality. 

As I started to approach the menopause, as did many of my patients, I realised that my knowledge around the subject was a bit patchy! So I took it upon myself to learn and train with the British Menopause Society. I’m so glad I did. After all, as a doctor, the only condition that all of my female patients will experience is menopause. That’s a lot of women. 

Menopause is defined. It means you haven’t had a period for over a year. So you don’t know you’ve had it until it has passed. The time leading up to that is called the perimenopause. That can last anything from a few months to several years. 

What are the symptoms of the menopause? 

The main symptoms of depleted hormones are hot flushes, night sweats, poor sleep, anxiety, joint pains, brain fog, vaginal dryness, and lack of libido. Your periods may stop, be irregular or remain regular. Sounds horrendous, doesn’t it! 

What is HRT? 

Hormone replacement therapy. It replaces the female hormones - oestrogen, progesterone and sometimes testosterone. 

Why is it important to replace these hormones? 

Oestrogen is vital for our bone strength, it protects the heart, brain, vagina and bladder. Progesterone helps with mood regulation and with sleep. Testosterone is good for the heart, the bones, our drive and sexual desire. In the short term, the symptoms of the menopause are controlled, and in the long term, we are investing in significantly better health for when we are old ladies!  

When should you start and stop HRT? 

You can start on a low-dose HRT as soon as you notice any of the symptoms of the perimenopause. The general advice has been to stop HRT after five years, but there is no evidence to support this, and if women feel well, we advise that they can continue with HRT.  

What are the risks? 

My view is that the benefits of HRT far outweigh the risks. Women often ask me about the risk of breast cancer. For every 1000 women taking HRT, there may be an extra 5 diagnosed with breast cancer after 7.5 years. HRT may promote the growth of breast cancer cells already there, but it will not give you breast cancer. The evidence seems to suggest that the synthetic progesterones may be the problem, and personally, I don’t prescribe those. Remember also that most women die from heart disease, and evidence suggests that HRT can significantly reduce the risk of heart disease. By the way, HRT doesn’t make you fat… It’s a lack of the hormone oestrogen that does that! 

What are bioidentical hormones? 

Bioidentical hormones are hormones that are structurally the same as those that we produce in our bodies. I prefer to call them body identical to differentiate them from the hormone treatments that are specially formulated with mixtures of different hormones.  In my opinion, the vast majority of women don’t need these bespoke mixtures, and body-identical hormones are available on the NHS, but many doctors aren’t aware of it. I feel that these hormones are better tolerated as our bodies recognise them as familiar structures. I do, however, feel that every woman needs an individual assessment of her symptoms and of her 

risk of other conditions. It’s an important time of life to stop and take stock of where you are both physically and emotionally. It should be a liberating time of life, and sometimes it isn’t. 

Make sure that you speak to a doctor or nurse who is interested and clued up on the menopause so that you get the best possible advice. It’s well worth it. 

Why not take a look at our specialist Menopause Retreats with experts in their field at various retreats around the world? For example our hormonal health and longevity programmes at SHA Spain Wellness Clinic or our energy renewal and hormonal harmony programmes at Lefay Resort & Spa Dolomiti in Italy or call us for your own personalised wellbeing programme on 020 3735 7555.