Hormone replacement therapy, or HRT as it’s commonly known, can be a phenomenal, life-enhancing treatment. Whether it’s tablets, patches, sprays or gels, it can help combat some of the worst symptoms of menopause – from hot flashes and insomnia to low mood and muscle aches.
But for women who have had breast cancer, unfortunately, this is usually not an option.
HRT works by supplementing the drop in estrogen levels – the same hormone that leads to many breast tumors – and this increases the risk of cancer recurrence. So these women are usually told to stay away.
Hormone replacement therapy, or HRT as it’s commonly known, can be a phenomenal treatment that improves women’s lives
In the Mail on Sunday last week, my colleague, Dr Liz O’Riordan, a former breast cancer surgeon who herself had breast cancer twice, wrote about it in detail and received an outpouring of support from the breast cancer community and women’s health experts.
They had been extremely concerned by recent claims by influential GP and menopause specialist Dr Louise Newson that ‘most of the evidence’ suggested taking HRT after breast cancer was safe – when in fact, the research indicates otherwise.
As a hormone physician with three decades of experience treating women, I know how confusing and distressing statements like this can cause patients.
But today I’d like to share a message of hope: if you can’t take HRT, due to cancer or another health reason, there are many other treatment approaches that can help combat the symptoms of menopause.
The same is true for about half of women who find that HRT does not relieve all their symptoms, or find that they suffer from side effects and need to stop.
Here are some options that I recommend in the clinic, almost daily.
Be active to beat the symptoms
If you choose to do one thing to improve your well-being during menopause, it should be to move more. Many studies have shown that women with menopausal symptoms who exercise have a much better quality of life than those who don’t.
Clinical trials on women not on HRT have also shown that regular physical activity helps reduce the severity of hot flashes over the long term. This could be due to improved cardiovascular function. But exercise is also known to help reduce stress and improve mood and sleep patterns, which makes it easier to manage hormonal changes. It can be three or four sessions, lasting 20 minutes to an hour, including a gentle warm-up, stretching and walking.
Regular exercise reduces the risk of stroke and coronary heart disease by up to 35%, type 2 diabetes by 50% and the risk of hip fracture by 68%, according to some research. It also lowers the risk of developing dementia and certain cancers.
On top of all that, regular exercise reduces the risk of stroke and coronary heart disease by up to 35%, type 2 diabetes by 50% and the risk of hip fracture by 68%, some say. research. It also lowers the risk of developing dementia and certain cancers. These effects are better than any medicine. In cancer survivors, this level of exercise also reduces the risk of breast cancer recurrence by more than 50%.
Do something you love, make it sustainable – not a huge, exhausting workout – and you’ll reap the benefits.
It’s time to watch your weight
In studies, three key symptoms of menopause worsen as women increase in size: hot flashes and night sweats, muscle and joint problems, and bladder problems.
The average adult is estimated to consume about 300 more calories per day than the recommended totals of 2,500 per day for men and 2,000 for women. But trying to lose weight by restricting calories, as many know, isn’t easy. If you find a diet that works for you, great. But most doctors agree that it’s more about trying to eat more foods that we all know are good for us – vegetables, grains, lean proteins, that sort of thing – which should we leave less room for cakes, cookies and other snacks.
Making small, incremental changes to your eating habits is the most sustainable way to improve your long-term food intake. How you do this will be unique to you because we are all different.
In studies, three key symptoms of menopause worsened as women increased in size: hot flashes and night sweats, muscle and joint problems, and bladder problems.
Find ways to de-stress
Anxiety and chronic stress are common issues for middle-aged women who often juggle work, children and family, and perhaps caring for an older relative.
If anxiety is a particular problem, your GP can help: antidepressants or other medications may provide some relief. Meanwhile, cognitive behavioral therapy, or CBT as it is also known, is a type of psychotherapy that has been shown to help relieve a number of symptoms of menopause, including anxiety.
Three clinical trials, which included breast cancer patients, showed that CBT, given in weekly sessions for four to six weeks, also reduced hot flashes and night sweats, as well as sleep problems. It is an NHS-approved treatment, and GPs can refer women to a therapist. However, waits can be long.
The British Menopause Society recommends a self-help book on CBT for menopause, Managing Hot Flushes and Night Sweats: A Cognitive Behavioral Approach to Menopause, by Myra Hunter and Melanie Smith – which is available from the publisher Routledge ( routledge.com) in paperback and ebook for £11.99. It is a four week program.
I’m not saying that means the hot flashes are all in the head. It makes sense – if you can stay calm, you’ll feel less hot and bothered. My patients find the approach really helps. If insomnia is a problem – as it often is for postmenopausal women – there are also special CBT smartphone apps for insomnia. Sleepio (sleepio.com) is a good option. It is important to note that all of these things also help even if you are on HRT.
Discover other drugs
There are also non-hormonal medications that we can prescribe. Clonidine is a drug primarily used to treat high blood pressure which is also licensed for hot flashes. It can also help with sleep problems and headaches.
Oxybutynin can help with bladder control issues, but also reduces sweating, if that’s a problem.
I mentioned antidepressants earlier, but some of them – low-dose venlafaxine, citalopram or escitalopram, or duloxetine – can specifically relieve flushing, night sweats and sleep disturbances.
Another antidepressant, bupropion, can help lower libido – although it can be difficult to get on the NHS as it is not licensed for this use.
Gabapentin or pregabalin, nerve pain relievers, can relieve anxiety, pain, sweating and sleep, but we are extremely careful about offering them as addiction and withdrawal can occur.
Vaginal estrogen may benefit vaginal symptoms such as discomfort, intimate pain, and recurrent water infections. It is safe for most women even after breast cancer and has no side effects.
Take the natural route
People are often scathing about natural menopause remedies and supplements, mostly because there’s no evidence that they work.
But I always say it’s reasonable to try something natural if it’s safe – and if it’s available on the High Street it probably will be – won’t break the bank, and you think it might to help. If it doesn’t provide the promised relief, then don’t persevere. I would say the same for things like acupuncture and reflexology, which anecdotally help relieve stress.
When it comes to menopause, every woman is different – but every woman should adopt a range of holistic strategies outside of HRT, to ease the transition into menopause. These will also reduce your long-term health risks.
If you can take HRT and it works for you, great. Otherwise, no HRT should be a problem.