Dispelling the top 7 most common myths about HRT

There is a lot of information regarding HRT - some true, some false. Bia Care is here to identify those myths and answer common questions that women have regarding HRT so that you feel you can make an informed decision moving forward.

Myth 1: HRT causes breast cancer

This is one of the most common concerns that women have when considering HRT - and honestly, it is a significant reason women choose not to take it.
In most women who are at average to low risk of breast cancer (90% of women), the symptomatic benefits of HRT will exceed the potential harm - meaning your benefits outweigh the risks. Something to keep in mind is that for women with premature ovarian insufficiency (POI), the years of HRT should be counted from the age of 50, not when you start taking HRT.
Breast cancer risk varies, however, depending on your personal risk factors and the type of HRT you use. For example, suppose you have a family history of breast cancer. In that case, your baseline breast cancer risk may be higher than average, and Bia Care can offer an individual assessment and discussion with a specialist doctor before considering HRT.

If you have no extra risk factors for breast cancer, however, the following apply:

  • If you have had a hysterectomy (your womb removed), you would be prescribed estrogen-only HRT, which doesn't affect your risk of breast cancer. In fact, estrogen-only HRT is associated with a reduced chance of dying from breast cancer.
  • If you still have your womb (have not had a hysterectomy), you will need combined HRT. This contains both estrogen and progesterone hormone replacement. Combined HRT can be associated with a small increased risk of developing breast cancer depending on how long you take it, but this risk is not associated with an increased risk of dying from breast cancer. This risk will also vary depending on personal factors, including family history and lifestyle factors such as weight, alcohol intake and smoking. Continuous combined HRT will also give a slightly higher risk than cyclical. The extra risk, however, is very small, and this risk will reduce once you stop taking the HRT. It is good to note that continuous combined HRT has the added benefit of reducing the chance of developing endometrial cancer.
  • Something to note is that there may be some difference in risk of combined HRT depending on the type of progesterone used, with some evidence suggesting that micronised progesterone such as Utrogestran has a more negligible effect on breast cancer risk.

Myth 2: HRT must be used for as little time as possible

Women can take HRT for as long as they need, providing they are continuously assessing their risk:benefit ratio. It is widely accepted that HRT should not be time-limited and can be taken for much longer than 5 years. Those who have had a surgical or early menopause should even be recommended HRT for long term use, as they are at a higher risk for osteoporosis and cardiovascular disease.
Low dose vaginal oestrogen is very low risk. Most women can take this safely for as long as they need it to keep vaginal symptoms under control.
There is no set point when you must stop hormone treatments as symptoms may return when discontinued. But, the risk-benefit profile of HRT does change over time. This is why it's crucial to have regular, annual check-ins to assess if HRT is still the right choice for you. Most doctors would review the risk-benefit balance around the age of 60 years.

Myth 3: HRT increases risk of cardiovascular disease

If HRT is started under the age of 60 years it may protect women from the risk of developing a heart attack. Current evidence suggests that there is a 'window of opportunity' of about 10 years between 50 and 60 years when HRT protects the blood vessels and heart. Starting HRT after age 60 may not give this protection, but recent long-term studies suggest that there is no increase in cardiovascular problems if you start HRT over the age of 60, and HRT is still beneficial for bone and brain health.
Your personal risk depends on your medical history, with higher risks if you have high blood pressure or diabetes, your family history of heart disease and lifestyle factors, such as smoking, weight and diet.

Myth 4: HRT makes you gain weight

It is not uncommon to gain weight during menopause, but this is not because of HRT. Instead, this is often a result of women becoming less active, your hunger levels changing, and menopause itself. There is also an age-related decline in metabolic rate of around 10%. So you need to eat fewer calories to maintain a stable weight. Furthermore, as the oestrogen levels fall and free testosterone increases, there is an increase in fat deposition around the abdominal organs, even if weight is steady. This leads to thickening around the middle waist area - also known as 'middle-aged spread'.
HRT can help balance the hormone changes, and in some women will lead to more effective weight management. It does not cause you to 'lose weight', but it can help prevent weight gain around the middle.

Myth 5: HRT is 'unnatural'

Modern HRT, the type prescribed by Bia Care doctors, is made from plants and is called 'body identical.' Body identical means that the chemical structure of the hormones in the medication is exactly the same as those in your body. So, taking this type of HRT is a natural way to top up the hormones which are lost as you pass through menopause.
Older types of HRT, and some tablets, contain synthetic hormones. These are not entirely identical to your own hormones. They may have different risks and side effects to body identical HRT, but can be used safely in many women. If you are on an older HRT preparation and it suits you, then there is usually no need to change it.
HRT is the most effective way to reduce menopausal symptoms. But, this does not mean that HRT is the only option. There are lifestyle modifications and natural remedies that may help improve your symptoms. Cognitive behaviour therapy (CBT), for example, can reduce the effect of hot flushes and night sweats and may improve anxiety. Keep in mind, however, that natural remedies or supplements have not been researched to the same extent as HRT, and are unlikely to be as effective.

Myth 6: You only need HRT when things are 'really bad'

HRT can provide relief for both mild and severe symptoms. You do not have to wait until your symptoms are severe, unless that is something you want to do. Additionally, HRT provides more health benefits for your heart and bones when started at a younger age. So, there is no reason to suffer through symptoms or wait to start.

Myth 7: HRT will cure my symptoms in a couple of days

HRT can take up to 3 months to have an effect. This is because your body needs time to adjust to the new hormones that are being reintroduced. If you have not seen any benefits at all from HRT within 3 months, then it's an indication that perhaps your symptoms are not being caused by your hormones. And this is a cause for investigation.
Some women will feel good by 3 months, but perhaps not fully back to themselves. This indicates that your HRT dose may need an adjustment. This is why having a 3 month check-in is essential. It can take a few adjustments to find the right balance for you, and that's why tracking and monitoring your symptoms using Bia's symptom tracker as you start HRT is so important.

Every woman reacts differently when they start HRT. Some lucky women will feel almost the full effects of HRT in days, whilst others will take longer to respond. It is also important to understand that you might experience some mild side effects in the early days before the benefits of symptom improvement kick in, and these tend to subside.

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