Hot flushes, night sweats, vaginal dryness
Many women, although not all, experience uncomfortable symptoms during and after menopause, including hot flushes, night sweats and vaginal dryness. These symptoms, and the associated physical changes, can be managed in various ways including education and lifestyle changes like diet and exercise. Hormone replacement therapy (HRT) is also available if required. While HRT reduces the risk of some debilitating diseases, it also increases the risk of others.
Symptoms of menopause
Menopause occurs when a woman stops ovulating, the ovaries no longer produce oestrogen (one of the female sex hormones) and her monthly period (menstruation) ceases. It is a natural event that marks the end of the reproductive years. Removal of the ovaries surgically can also cause a surgical menopause with the associated menopausal symptoms.
- Hot flushes
- Night sweats
- Vaginal dryness
- Thinning of vaginal walls
- Vaginal and bladder infections
- Mild urinary incontinence
- Cognitive changes, such as memory loss
- Reduced sex drive
- Mood disturbance
- Hair loss or abnormal growth
- Dry and itching eyes
Hormone replacement therapy
HRT needs to be individually tailored. Some women experience side effects during the early stages of treatment, which may include:
- Breakthrough bleeding
- Breast tenderness
- Blood clots
Various studies prove that weight gain is NOT linked to HRT.
Hormone replacement therapy benefits
HRT reduces the risk of some chronic conditions that can affect postmenopausal women, including:
- Osteoporosis – thinning of the bones to the point where they break easily is reduced by HRT
- Bowel cancer – the risk of colorectal cancers is slightly reduced with HRT
HRT risk factors
While HRT reduces the risk of some debilitating diseases, it also increases the risk of others. These small risks must be balanced against the benefits for the individual. Four areas of concern are:
- Breast cancer – current research suggests that women over 50 years of age, who use oestrogen and progestogen replacement for less than five years, have little or no increased risk of breast cancer. Women who use HRT with progestogen for more than five years appear to have a slightly increased risk. Women on oestrogen alone appear to have no increased risk up to 15 years of usage.
- Cardiovascular disease – current research suggests that women over 60 have a small increased risk of developing both heart disease and strokes on combined oral HRT.
- Thrombosis – these are blood clots that form inside veins. Some women on HRT are more likely to get thrombosis than women who are not on HRT.
- Endometrial cancer – this is cancer of the lining of the uterus. Long-term use (for 10 years or more) of oestrogen alone increases the risk of this cancer, but this risk is neutralised with the addition of progestogen to the treatment. There is no risk if a woman has had a hysterectomy.
It is currently believed that, overall, the risks of long-term HRT use outweigh the benefits. HRT should not be recommended for disease prevention. However, in women with long-term severe symptoms, HRT may be the only effective therapy.