My periods have stopped and I feel fine. Do I need HRT? Every woman’s hormonal journey is going to be very individual, but there will be similarities too. The one event we will all experience is menopause i.e. cessation of all our ovarian hormones, no more eggs being produced and the end of our fertile career.
The hormones that kept us fertile, fit and youthful start to decline. Some of us will be aware of the change in the hormonal milieu and will experience overt symptoms and others will not. Does this, however, mean that the women who have no symptoms do not have reduced blood levels of estrogen, progesterone and testosterone in their menopause? Definitely not. We will all have reduced levels of these vital hormones and we will all be at increased risk of those disease conditions that have so far been warded off to a certain extent by our hormones. So, what is happening backstage?
What is happening now that my periods have stopped?
- We lose 5% of our bone mass in the first year of stopping our periods and 1% every year after that. This eventually can lead to osteoporosis or brittle bone disease that makes us prone to fractures later in life. What happens to us in our seventies has been taking shape as our estrogen levels decline. Estrogen is the key for maintaining healthy bones and works with our calcium and vitamin D: the healthier our bones, ligaments and cartilage the less wear and tear to our joints.
- There is good evidence that commencing HRT (hormone replacement therapy) between the ages of 49 and 59 can reduce our risk of strokes and heart attacks by up to 30%. We know that after 50 this risk goes up for women and it is related to estrogen decline. Estrogen helps maintain healthy collagen, elastin and therefore the pliability and health of the blood vessels. It’s the quality of all this “plumbing” that needs to be maintained in order to prevent wear and tear, or subsequent narrowing resulting in a blockage. It is the blockage of the small blood vessels in the heart muscle and brain that causes heart attacks and strokes, with subsequent tissue death as the blood supply is interrupted.
- Skin health, sexual and bladder function will all be impacted by lack of estrogen. The skin will become drier and so will the lining of the vagina. The impaired blood supply in these tissues of the vagina, for example, impacts on cell repair, nutrition and sexual response. Vaginal dryness can lead to discomfort during sex along with cystitis. The bladder starts to get moody and sensitive, needing us to go more frequently and often in a hurry. Visits to the toilet during the night become the norm, which can cause disturbed, poorer quality sleep.
- Mental health and sleep: Natural progesterone is our body’s feel good and anti-anxiety hormone. It helps with aches and pains, which we start to feel in our peri menopause and menopause. Balancing our hormones can help our mood and stop us swinging between happiness, sadness, tears and apathy. Micronised progesterone is bioidentical and delivers these benefits. Estrogen has its own contribution to make towards our happy chemicals, one of which is serotonin.
So, although we do not need the levels of hormones that we had in our fertile life, replacing hormones appropriately for an individual woman can help maintain her health and prevent disease. Genetic factors, diet and lifestyle all also have a role to play towards our health.
Discussing HRT is not about replacing the above, but investigating if there is anything further we can do to improve and maintain our health and prevent disease where we can. Balancing hormones can have a positive impact on our overall health. The clinical ethos should always be to use hormones that are bioidentical to those produced by our own ovaries. The ones that promise the most benefit with the lowest level of perceived risk. These are available within the NHS from your GP.
It is your menopause and it is your second half of the game. You choose how you play it, but do not make a choice without knowing the facts. Make an informed decision.
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