Menopause is a transition that all women go through but it can be as confusing and complicated as you try to navigate your way into this new phase. You may be experiencing a number of new symptoms the most common being: cycle changes, hot flushes, anxiety, insomnia, urinary tract infections and brain fog. And now you are expected to make decisions about treatment (for example MHT) at a time when you are feeling debilitated. It’s a very tricky space to be in!

Unfortunately, the lack of accurate information and the spread of misinformation have led to unnecessary fear and confusion surrounding menopause. In this Flo Hive article, we will debunk common myths about hormonal treatment and provide clarity on the facts.

The impact of estrogen on symptoms

One of the primary causes of menopausal symptoms is the loss of ovarian estrogen. Estrogen receptors are present in almost every cell of our bodies, and when estrogen levels decline, it affects various parts of our bodies, including the brain, bones, heart, skin, and more. This hormonal imbalance can lead to symptoms such as hot flashes, mood swings, and sleep disturbances just to name a few. In fact there are 34 commonly recognised symptoms of menopause.

To address these symptoms, hormone therapy has been a common practice. In the past, adding a small amount of estrogen back into the body was a standard approach.

TGA-approved hormone treatments, available as pills, gels or patches, not only alleviate menopausal symptoms but also reduce the risk of osteoporosis and type 2 diabetes. For women with a uterus, progesterone is also essential to accompany estrogen therapy.

The controversy surrounding hormone therapy

Numerous misconceptions surrounding menopausal hormone therapy (MHT) have arisen from the Women’s Health Initiative (WHI) studies conducted in 2002 and 2004. However, recent advancements in understanding MHT have enabled doctors to gain better insights into its risks and benefits. The Australasian Menopause Society states that MHT remains an effective method for managing menopausal symptoms and even offers certain health advantages to some women. Extensive research has revealed that combined MHT (estrogen and progesterone) do not significantly increase the risk of breast cancer or heart disease among women aged 50 to 59 or those who initiate treatment within a decade of menopause.

Debunking common menopause myths

Myth: Estrogen therapy causes breast cancer

Truth: estrogen replacement therapy does not increase the risk of breast cancer over a woman’s baseline risk. The WHI study, which initially raised concerns, once re-evaluated has in fact found that women who took estrogen alone actually had a decreased incidence of breast cancer. The small increased risk found in the study was related to the type of progesterone used, not estrogen itself.

Myth: Testing hormone levels is necessary before starting treatment

Truth: There is no requirement for hormone level and other tests to confirm menopause but there are tests available to do at home with quick results such as the Proov Test (paid link). Your doctor is unlikely to order bloodwork and would determine your status (perimenopause/ menopause) based on your symptoms. A woman is classified as postmenopausal if she is over fourty-five and has experienced twelve consecutive months without menstruation. For women who are experiencing menstrual cycles with menopause type symptoms this is the transition phase before menopause – perimenopause. Perimenopause typically commences in your mid 40s.

Myth: every woman needs customised hormone blends

Truth: There are TGA-approved standard doses of estrogen that are widely available and effective for the majority of women. While some individuals may require adjustments in dosage, the right dose is determined by symptom relief, and there is no need for specialised formulations. Whilst you can purchase estrogen creams (paid link) from America these contain bioidentical hormones and not recommended by the Australasian Menopause Society.

Myth: Hormone therapy can only be taken for a limited time

Truth: Contrary to the guidance provided in MHT product information, the International Menopause Society suggests that there is no requirement for a compulsory time restriction on the duration of MH. In fact, recent research involving data linkage has revealed that women who ceased MHT experienced a notable rise in cardiovascular and cerebrovascular mortality rates compared to both the general population and those who continued. It is worth noting that over 20% of women will encounter moderate-to-severe symptoms after discontinuing MHT.

Addressing symptoms and vaginal health

Menopause can bring various symptoms that impact a woman’s quality of life. One common issue is genitourinary syndrome of menopause (GSM), which includes symptoms like vaginal dryness, itching, painful sex, urinary incontinence, and frequent urinary tract infections. Hormone therapy, particularly when started early, can prevent GSM. However, when systemic therapy is not desired or contraindicated, vaginal estrogen can be used to alleviate symptoms.

Individualised risk assessments

When it comes to hormone therapy, individual factors should be taken into account. Contrary to popular belief, having a family history of breast cancer does not automatically disqualify a woman from hormone therapy. A well educated doctor can advise you of the risks. 

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