Do the benefits of HRT outweigh the risks of side effects?

Do the benefits of HRT outweigh the risks of side effects? As Nicola Bulley hunt triggers fresh debate around the life-changing pills, doctors weigh in on if ALL menopausal women need to take them

• The NHS estimates nearly 2million people in the country are now taking HRT
• Read more: Dog walker reveals moment he found Nicola Bulley’s phone on bench

A Davina McCall-inspired menopause revolution has triggered a surge in women wanting to take hormone replacement therapy (HRT) over the past few years.

But the case of Nicola Bulley, who reportedly stopped taking HRT due to suffering ‘intense’ headaches before her shocking disappearance, has sparked a fresh debate over the drugs.

Some experts have told MailOnline that the pills, gels and patches are not a ‘one size fits all’ approach to combating the brutal effects of ‘the change’.

The NHS estimates nearly 2million people in the country have been prescribed HRT.

For many it has provided crucial lifeline for easing symptoms common symptoms of the change such as mood swings, hot flushes and night sweats.

Nearly 2million women in England struggling with hot flushes, night sweats and mood swings were prescribed hormone replacement therapy (HRT) in the year to March 2022 (black line). The figure is up by nearly a third on one year earlier, when 1.5million women were prescribed tablets, skin patches and gels to manage menopause symptoms. Meanwhile, nearly 8million items of HRT were dished out (blue line), up 35 per cent year-on-year. The nation was struck by a HRT shortage in 2022

A surge in interest in HRT came came after a menopause documentary by Davina McCall, 54, was broadcast in May 2021. She spoke of struggling with hot flushes from the age of 44. Pharmaceutical companies reported a spike in demand for HRT products following the release

Missing mother-of-two Nicola Bulley was battling drinking problems after going through the menopause, and ditching her HRT medication due to the side effects

But others have avoided it and sought out ‘natural’ methods or cannot take it due to underlying medical conditions. 

Menopause marks the point when a woman hasn’t had a period for 12 months in a row.

It usually happens between the ages of 45 and 55, with 51 being the UK average. 

It is a normal part of ageing and occurs because the ovaries stop producing eggs, meaning a woman can no longer get pregnant naturally.

As a result, levels of the hormones the ovaries produce — oestrogen, progesterone, and testosterone — drop.

Nicola Bulley’s father says ‘every day is a struggle’ and prays for breakthrough three weeks after mother-of-two vanished – as her sister says, ‘Time to come home now’ 

Ernie Bulley and his daughter Nicola – he is hoping for a breakthrough 

HRT provides an artificial source of these hormones, effectively blunting the menopause .

Millions hail the treatment for relieving most menopausal symptoms, such as hot flushes, night sweats, mood swings, vaginal dryness and a reduced sex drive.

However, like any medication, it carries a risk of side effects that vary in both rarity and severity. 

These can include bloating, breast tenderness or swelling, nausea, cramps, headaches, indigestion, vaginal bleeding, depression, and acne.

The individual risk of these symptoms varies depending on what form of HRT is taken, the dosage, and if a woman’s has certain health conditions. 

Studies have also linked HRT to a very slightly higher risk of breast cancer. But the risk falls once a woman stops taking the drugs.

And doctors have warned that celebrities advocating the treatment, such as Davina McCall and Gabby Logan, has led to a surge in demand in women assuming they need the treatment.

Some GPs have told how their patients going through the menopause have asked to be put on HRT even if they have no symptoms — citing FOMO (fear of missing out).  

Dr Shahzadi Harper, a GP in London and menopause expert, said: ‘There is no one size fits all HRT.

‘And, when starting, you can unfortunately sometimes experience side effects, headaches being one, depending on which HRT it is (and some women are more sensitive than others).

‘Whilst some may have no issues when starting HRT, others can and might need to try different preparations or maybe are so sensitive they have to stop.

‘I worry that so much attention has been given to just going on to HRT that not enough time is spent explaining the potential side effects, such as, nausea, breast tenderness, headaches, bloating.’ 

The NHS estimates nearly 2million people in the country have been prescribed hormone replacement therapy (HRT) tablets, patches and gels

BBC presenter Gabby Logan was diagnosed with perimenopause — the time before your last period when the body transitions into menopause — at the age of 47

Menopause marks the point when a woman hasn’t had a period for 12 months in a row. It is a normal part of ageing and occurs because the ovaries stop producing eggs, meaning a woman can no longer get pregnant naturally. As a result, levels of the hormones the ovaries produce — oestrogen (shown in graphic), progesterone and testosterone — drop

The NHS advises people who suffer side effects to continue to try and persevere for three months if possible as they can stop as the body gets used to the medication. 

However, women should contact their GP if they suffer ‘severe’ side effects or if they persist beyond three months. 

Dr Harper said: ‘Expectations are too high for a quick fix, and so many are not aware that it may take time to settle and not to rush to too high a dose.

‘I recommend start low and go slow — if you experience side effects or problems talk to your [healthcare professional]. You should be supported by your doctor.

‘A common phrase I use to my patients is, “I know that there can be a few bumps in the road when starting on your HRT journey- but I’m here to support you”.’

WHAT IS THE MENOPAUSE? 

Menopause is when a woman stops having periods naturally and is no longer able to get pregnant naturally.

It is a normal part of ageing and usually happens between the ages of 45 and 55 when a woman’s levels of the sex hormone oestrogen drop. 

Eight in 10 women will experience menopausal symptoms including hot flushes, night sweats, vaginal dryness, difficulty sleeping, low mood or anxiety and problems with memory.

Women are advised to see their GP if their symptoms are difficult to manage.

Treatments doctors can provide include hormone replacement therapy, such as tablets, skin patches and gels that replace oestrogen. 

Source: NHS

She said that most women ‘do definitely feel the benefits of HRT’ but finding the best option for each person can take a while.

Dr Harper said: ‘Few women are sensitive and may not be able to tolerate HRT then options like anti-depressants can be equally good — anti depressants shouldn’t be written off.’ 

She warned people not to ‘suddenly stop’ taking HRT as this can cause rebound symptoms, so people should instead talk to their doctor and wean off their dose. 

Dr Harper added: ‘I think unfortunately Nicola stopped without guidance and without knowing the potential side effects that can come when one starts taking HRT. 

‘HRT is not a quick fix and it doesn’t suit everyone.’

Some women are unable to take HRT, including those with breast, ovarian or womb cancer, untreated high blood pressure, liver disease or a history of blood clots.

And some decide not to take it.

The NHS advocates regular exercise, a healthy diet as well as cutting down on coffee, alcohol and spicy foods and stopping smoking as alternatives.

It also suggests tibolone — a medicine similar to combined HRT — along with antidepressants, which can help with hot flushes and night sweats, and clonidine — a non-hormonal medicine which may ease symptoms for some women.

And some complementary therapies — such as the plants black cohosh and St John’s wort — may help reduce hot flushes, according to the health service.

But it warns that ‘many’ complementary therapies are not supported by evidence. 

Jennifer Young, who founded menopause skincare bran Menopause Plus and trains organisations to become menopause friendly, told MailOnline that HRT can be ‘wonderful’ for some women but ‘isn’t suitable for others’.

‘HRT benefits those who can and want to use it by smoothing the declining levels of hormones associated with the menopausal years,’ she said.

But her company estimates that around 7million in the UK don’t want to use HRT — either because of a medical condition or because they prefer a ‘natural approach’. 

She said: ‘These women turn to evidence-based complementary therapies and benefit from lifestyle changes.’

Ms Young said: ‘HRT isn’t the only solution for those who can use it and, many of those who can, prefer not to. 

‘Menopause and its treatments are not a binary issue – both affect different women in different ways. 

‘It is important to listen to women, to respect their privacy and preferences, understanding them, helping them find a path that suits them. 

‘As with all medication designed to be taken in the long-term, if you are thinking of coming off it, you should always speak to your doctor first.’ 

Women can get a prescription for HRT as soon as they start experiencing menopausal symptoms.

Doctors tend to dish out a low dose initially, which can be increased later, and recommend trying the treatment for three months to see if it helps.

If women decide to stop taking HRT, medics recommend doing so gradually as it is less likely to cause symptoms to come back in the short-term.

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