Beyond Hot Flushes

Menopause Hormone Therapy
Dispelling the Myths
Menopause hormone therapy (MHT), also referred to as HRT, can be an effective treatment for symptoms of perimenopause or menopause.
Some myths surrounding MHT may result in women being hesitant to consider MHT as a treatment for significant menopausal symptoms or being incorrectly denied MHT. It would be helpful to dispel some of the common myths:
Myth 1
MHT causes breast cancer.
The latest research shows that oestrogen-only MHT (may be suitable if a woman had hysterectomy) does not increase risk of breast cancer above woman’s own risk. Combined MHT of oestrogen and progesterone (the most common type of MHT) is associated with a slight increase in the incidence of breast cancer above own risk. Clinical trials show that if 1000 women aged 50-59 took MHT for 5 years, there would be 4 additional cases of breast cancer. To put this risk into perspective, if 1000 women in the same age group have 2 alcohol drinks regularly for 5 years, that alone would also result in 4 additional breast cancer diagnoses. Furthermore, in the same age group having a BMI greater than 30 increases breast cancer risk by an additional 24 cases per 1000 women, which is 6 times greater than the risk associated with MHT alone. Whereas, regular exercise reduces the risk by as much as 7 fewer cases. In short, MHT is associated with a relatively small increase in incidence of breast cancer. There are certain lifestyle factors that, if corrected, can reduce a woman’s overall risk of breast cancer.
Myth 2
Women with family history of breast cancer cannot have MHT.
This is not true in many cases. Risk of breast cancer based on family history can be classified as: low, moderate or high. An example of low risk family history would be having a great-aunt who had breast cancer after 60. This is representative of typical population risk – 1 in 7-8 women in the Western world will be diagnosed with breast cancer in their lifetime, therefore many families are reasonably likely to have one relative with a history of breast cancer. Women at a moderate or high risk of breast cancer are encouraged to discuss their options and weigh up risks and benefits with a menopause specialist.
Myth 3
Women with history of blood clots cannot have MHT.
Some types of MHT do increase the risk of blood clots (such as deep vein thrombosis or pulmonary embolism), whereas other types of MHT do not. If there is family or personal history of blood clots or a known condition that predisposes to blood clots, it is important to consider the correct type of MHT. In addition, other measures can be taken to reduce the risk of blood clots.
Myth 4
If you are on MHT you do not need contraception.
Going through perimenopause does not mean a woman cannot conceive. Recently the highest relative increase of unplanned pregnancies was observed in the over 40s age group. Therefore women are under the age of 50 and periods stopped less than two years; or for women over the age of 50 and periods stopped less than one year, then contraception options need to be discussed alongside MHT.
For a woman, the decision whether to take MHT, the dose of MHT and the duration of its use should be made on an individualised basis after discussing the benefits and risks with a doctor.