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For some women experiencing the symptoms of menopause, HRT can be a godsend, but once you hit the big 6-0 fewer and fewer GPs are willing to prescribe it - though you may still be suffering menopause symptoms. So, what happens next? Here's our guide to HRT for over 60s.
In short, HRT is a man-made replacement for the hormones your body stops producing once you hit menopause (progesterone and oestrogen). HRT is taken to ease the symptoms of this dive in hormone levels. Menopause symptoms can include:
These symptoms may not all present themselves during menopause, and there are a few things that can help ease the severity of those that you do experience, namely cutting specific things out of your diet and getting regular exercise. Where these two measures fail, there's HRT.
HRT comes in various forms, from tablets and patches, to gels, creams and even implants. What is right for you will depend on the symptoms you are experiencing, and should be talked over with your doctor.
Tablets are the most common form of HRT, with the patches following a close second. Both of these options are available in combined and oestrogen-only forms, and the patches are replaced every few days, while the tablets are taken every day.
Oestrogen-only forms include a daily oestrogen gel, vaginal pessary and an implant, placed just under the skin. Here's an overview of the different forms of HRT, including the downsides and benefits of each:
|Type of HRT||Pros||Cons||Good for...|
|Tablets (oestrogen-only)||- Prevention of osteoporosis
- Helps with hot flushes
- Helps fight heart disease
|- Slightly higher risk of blood clots and endometrial cancer
- Not suitable for those with liver problems
- Not suitable for women with a uterus (it would have to be taken with some form of progesterone as well)
|Women who have had a hysterectomy and women under 60|
|Tablets (combined)||- Thought to lower risk of colo-rectal cancer
- The combination of oestrogen and progesterone means that endometrial cancer risk is not raised
|- Slightly higher risk of blood clots, stroke, breast cancer and heart attack||Women under 60|
|Patches||- Thought to be safer than tablets because of the slower release of hormones, which are then less likely to affect the liver
- Thought not to raise the risk of blood clots
- Slightly milder side-effects than tablet form
|- Not enough studies to prove that this form of oestrogen doesn't slightly raise risk of blood clots, stroke, breast cancer etc.
- Patches must be kept out of direct/strong sunlight (no good for holidays!)
- Can cause some skin irritation
|Those with bowel disorders - absorption through the skin is kinder on the gut and liver|
|Oestrogen gel||- Again, easier on the liver since it is absorbed through the skin||- Not enough studies to prove that this form of oestrogen doesn't slightly raise risk of blood clots, stroke, breast cancer etc.||Those with bowel disorders - absorption through the skin is kinder on the gut and liver|
|Vaginal pessary||- Stay in place for about three months at a time
- Most effective when it comes to vaginal menopause symptoms
- Some of them are low dose, so good for those only experiencing vaginal symptoms
|- They are only designed to ease vaginal symptoms, so won't help with things like hot flushes or mood imbalance||- Those who suffer vaginal dryness or itchiness
- Those who cannot take HRT but are suffering the vaginal symptoms
|Implant||- Lasts for around 6 months||- The implant may result in higher levels of oestrogen, often meaning increased side-effects
- Those who have not undergone a hysterectomy will need to take progesterone as well
|Those who have had a hysterectomy|
|Bio-identical (plant-based) HRT||- Claimed to be identical in chemical structure to our own naturally-occurring hormones
- Addresses the hormone imbalance that causes menopausal symptoms
- Can reduce risk of osteoporosis
|- Many GPs are unaware it is available from the NHS (estradiol cream)
- Can be sourced privately through places like the Marion Gluck Clinic
- It hasn't been around long enough for large, thorough studies to be carried out on its effects (or side-effects)
|- Those who react negatively to hormonal medications
- Could be a better alternative for women over 60, as there are fewer risks associated with it
Most women hit menopause between the ages of 45 and 55, but that varies. The average age is 51. It's also worth keeping in mind that not everyone opts for HRT and it may not be suitable for some, including those with a history of breast and ovarian cancer in the family.
If you find that your GP won't prescribe you HRT, but you feel you would like a second opinion, it could be worth going to a doctor who specialises in the menopause. You can find details of specific clinics in your area here.
"I am aware of the risks, but value my current quality of life. If day to day living is intolerable, then for me the risks are worth it."
As with most medication, HRT carries its own risks and side-effects. After a study in 2002 found that HRT was linked to increased risk of breast cancer, the number of women taking the drug plummeted.
While studies do show an increased risk of developing breast cancer when taking HRT, this risk also increases over time. So, if you start taking HRT in your fifties and are still taking it in your 60s, statistically, the risk will be increased. Generally, it's not recommended that women over 60 continue with HRT.
In cases where a woman is taking combined HRT (as opposed to oestrogen-only HRT, which carries a smaller risk) her chances of developing breast cancer are doubled. However, statistics also show that breast cancer risks return to normal within five years of coming off HRT.
There is also a suggestion that bio-identical HRT (which, unlike standard HRT, carries the same chemical structure as the naturally-occurring hormones in our bodies that decline during menopause) might be safer for women over 60, though not enough studies have been done yet to come to a conclusion on the possible side-effects. We spoke to Dr. Marilyn Glenville PhD, the UK's leading nutritionist specialising in women's health:
"Research suggests that it is not appropriate for women over the age of 60 to start HRT because the risks are higher. Bio-identical hormones are chemically similar in structure to the hormones your body would produce naturally, but they carry the same risks as conventional HRT and they are not licensed by the UK regulatory authorities. The bio-identical hormones are still made in a lab in the same way that the conventional HRT would be made and from the same sources. The big question is when would you stop taking them? If it is correct to replace those naturally declining hormones then you would need to take them forever."
These risks are best discussed with your doctor, who can help you make an informed decision as to whether HRT is right for you. You can also find more information on HRT and cancer risks on the Cancer Research website.
"I am convinced that very gradual coming off was the way to do it. The whole process took over a year but, apart from some hot flushes for the first six months I was off HRT, I am now more or less symptom-free."
The benefits of HRT are generally thought to outweight the rists in women under 60, or when used within 10 years or the beginning of menopause. But what about after 60?
As women reach this age, it's fairly common for GPs to start suggesting they stop, or gradually reduce their dosage. Gransnetters themselves mostly recommend reducing the dosage slowly to minimise the possible negative effects of symptoms making themselves known again.
If your GP has advised against taking HRT or you don't want to run the associated risks, there are many alternatives therapies to consider. That's the good news. The bad news is that studies have shown that even the most effective ones are still about 30% less effective in treating menopause symptoms than HRT. For those suffering less severe symptoms of the menopause though, they may be sufficient. Here are some of the alternatives:
Raise your oestrogen levels naturally - with food! Chickpeas, beans, soya milk, soya beans all contain phytoestrogens which work to raise levels that have taken a dive due to menopause.
Black Cohosh - it's important to note here that no studies have proven this medicinal plant is either safe or effective. That said, it seems to help with temperature regulation in some women, reducing night sweats and the severity of hot flushes. It can cause stomach upsets though, and in rare cases, can affect the liver.
St John's Wort - this supplement is proven to help with mood regulation, so could potentially be very helpful for those who suffer from depression during menopause. Do talk to your doctor before taking it though, as it is known to interfere with certain medications.
Dr Glenville says:
"I would definitely use dietary recommendations and natural remedies (I use NHPs MenoHerbal Support in my clinic) as the first choice for women going through the menopause. And for women over 60, the symptoms may actually be coming from the stress response."
"Symptoms can be connected to your adrenal glands – as your ovaries decline in the production of oestrogen your adrenal glands take over some of this role and produce a form of oestrogen. Trying to reduce stress from outside is not always easy and the only way you may be able to control what is happening is to control how you react to the stress. The other way to control the stress hormones is to watch what and how you eat. Adrenaline and cortisol are released as your blood sugar drops and can give you symptoms such as mood swings, irritability, crying spells, aggressive outbursts, tiredness, anxiety and tension, inability to concentrate, forgetfulness, sweating and lack of sex drive – many of the symptoms we associate with the menopause. So my recommendation is to sort out your blood sugar balance first as you may be surprised how many of the 'menopause' symptoms disappear."
"[My GP] tells me he has patients in their 80s who are still on HRT and as long as they are happy and healthy and have regular checks, he is happy for them to continue. Needless to say I am back on HRT - very low dose - and feeling great."
"I am 68 and suffer very badly with hot flushes. I had HRT patches for many years but the doctors are reluctant to prescribe them now."
"I would rather take it and face minimal risks (with no personal or family histories) than suffer the awful symptoms which were ruining all aspects of my life."
"The worst thing about coming off HRT though is that it has totally messed up my sex life! One becomes dry in a certain area and trying to sort that problem out is no fun. I am seriously thinking of going back on to HRT if my doctor will prescribe it again. I know the risks, but I also love my husband more."
"I took it for about 12 years and the first time I came off - I had taken it every other day for two months to lessen the impact - I had dreadful symptoms again. My GP put me back on it and the next time I did as someone else on here and took it for six days a week for a couple of months and then five etc. I kept a strict diary about when to take it and this time I was fairly OK - had some symptoms like the flushes, but this time they were bearable and of extremely short duration and eventually they stopped."
"I was on [HRT] for 10 years and stopped when I had a major surgery. The only symptom that came back were the flushes but they were much less intense and mostly daytime ones, which I dealt with fine."
"Like some here, I was on HRT for 10 years before the doctor suggested it was time to stop taking it. No weaning off. I honestly don't recall there being any particular side effects to giving it up. I certainly didn't go back to being the horrible semi-deranged person that the menopause made me into - HRT gave me my life and my marriage back."
"I made the decision not to take HRT, but what helped with hot flushes for me was a large glass of soya milk every day."
"Hot flushes all night long. So it's HRT for me, but if you can't then it's all the natural things, and above all - sorry to say - alcohol makes them ten times worse!"
"I think that one of the big difficulties with these decisions is that GPs and others seem to be clearly in one camp or another - my previous one was not prepared to prescribe it for me; whereas this one could not see why I might have any reason to worry about it."
Dr. Marilyn Glenville PhD is the UK's leading nutritionist specialising in women's health. She is the author of a number of internationally bestselling books including Natural Solutions to the Menopause and many others. Find out more about her clinics on her website, or call Dr Glenville's clinic on 01892 515905.
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