It has taken me a long time to write the next chapter on menopause. And why? Because I have been experimenting, not with HRT, but with natural hormonal balance treatment and alternative therapies. I am slowly becoming one of those women, who is using every single alternative possible to heal herself instead of walking into the pharmacy. The reason is simple: I already put enough medication in my body and science is behind me (well for some symptoms). Also, I can cope (this is another of my extremes which isn’t put to menopause but is certainly amplified by the ‘change’). And my periods have come back. Now, I never thought I would be talking so openly about my monthly cycles. But believe me, when I started bleeding again, I almost wanted to celebrate!! I never celebrated my period. And now every month, if there’s a drop of blood I’m almost ecstatic!! This again, is a positive change that perimenopause brings. Self-evaluation and stepping into an unknown territory of publicly speaking about periods, bleeding, hot flushes is immensely empowering (and I very much advise this approach) as it is profoundly healing.

But as the periods started and then stopped again, my hormonal imbalance was increasing. And, the hot flushes returned. So back on discussion about HRT or hormonal replacement therapy (for the benefit of my daughters who will be reading this). Books are out (again), Shitali and Sitkari pranayama (cooling breath) is getting practiced on a regular basis several times a day, yoga practice is adjusted to become more grounding and relaxing rather than heated (although a Fire practice does help me from time to time). And my diet is being changed, again.

But as I promised, first the benefits and contraindications of HRT:

I am 45 years old, therefore an ‘ideal’ age when permenopause starts (although my hormones started fluctuating three years ago) and HRT is the only therapy that is currently being recommended by the medical practitioners to women like me: non-smokers, under 60 and with no history of breast cancer in family. If you still have the womb (uterus) then your HRT will be Oestrogen with Progesterone. If there is no womb (after hysterectomy) then Oestrogen only therapy is recommended.

The benefits of HRT are: minimising the symptoms of menopause such as hot flushes, sweats, mood swings, irritability, insomnia, palpitations, joint aches, vaginal dryness and discomfort and urinary frequency and reducing the risk of osteoporosis.

The intake of HRT is controlled and monitored so women after the age of 50 should check the symptoms every 2 to 3 years (i.e. perhaps stop the medication) to determine whether or not treatment is still required. If symptoms return, the HRT can be restarted. The dosage should be low, and checked possibly increased after 3 months. All of this can be found in website links listed below.

However, as I’m on carbamazepine for epilepsy, my dosage should be increased or in a form of a patch (non-oral route. Alarm bells start ringing every time a mention of a drug being increased and contraindications with carbamazepine is mentioned.

As for osteoporosis, several other very effective treatments of osteoporosis are now available but HRT is useful if a woman has osteoporosis, or is thought to be at risk, and also has menopausal symptoms. It remains as the recommended preventive treatment for women with an early or premature menopause (me??)

Other possible benefits of HRT include reduction in risk of cancer of the colon (reference below), and reduced risk of Alzheimer type dementia, cataract formation and skin healing. These possible benefits are not currently regarded as indications for HRT though.

Now the risks (don’t get too alarmed)!

  • increased risks of breast cancer (with long duration HRT; more than 5 years), blood clot and, if HRT is started many years after the menopause, possible cardiovascular disease.
  • Breast Cancer – The use of HRT may promote the growth of breast cancer cells which are already present if HRT is taken for more than 5 years after the age of 50, in some women; there is no evidence that HRT causes breast cancer (reference below).

However, if HRT is started because of premature menopause, then the use of HRT up to the age of 50 does not increase breast cancer risk any more than in women who continue to have periods up to the age of 50. Additional risk from HRT only applies if it is then taken for more than 5 years after 50.

  •  Problems – deep vein thrombosis. Oral form of HRT has been shown to cause a small increase in risk of deep vein thrombosis. The greatest risk is within the 1st year of use and is most relevant to women who have other risk factors, highlighted above.
  • Endometrial Cancer – Oestrogen only therapy given to women with the womb, increases the risk of thickening of the lining of the uterus and eventually endometrial cancer. Daily oestrogen combined with progesterone reduces this risk but does not eliminate it.
  • Ovarian Cancer: uncertainty about the possibility of increased risk of ovarian cancer with use of HRT.

This list is rather significant. However, if you read “instruction leaflet” of any of my medications, the list of risks would be as long if not longer. If you read the list of contraindications and risks of just simple pain killer, it would be the same (perhaps a bit shorter).

With any medication it is always the case about weighing up the good against the bad. The risk/benefit balance of taking HRT varies between women and for each woman it changes every year.

It is generally considered, that the benefits of taking HRT up to at least the age of 50, far outweigh the risks. If you are under 60 and having menopausal symptoms, the benefits also outweigh the risks.

However, some women may not need HRT at all. Every woman should be supported and the choice will ultimately be very individual.

So, I am still not against taking HRT but have now decided to try balancing my hormones the natural way –relying on my Yoni yoga (including pelvic floor exercises and yogic mula bandha with an empty womb), meditation and pranayama to help me with mood swings and relaxation; pranayama to help me with hot flushes and diet and nutritional benefits of natural remedies such as red clover, broccoli, fenugreek, mung beans and eggshells to help me with hormonal imbalance.

I’m not sure if it is the right way, but I am happy trying it and being on it.

If you are interested in yogic practices that may help your menopausal symptoms, please get in touch. I hold regular workshops in Saffron Walden and Cambridge area.

Disclaimer:

I am not a medical professional and the above information is related to my research in risk and benefits of HRT so that I alone could make an informed choice about my use of HRT. In no way, is this article intended as an advice on menopause and HRT. Please visit your GP and discuss any concerns that you may have in relation to your menopause and HRT.

There are some very useful websites available, and the sources to this article are revealed below. Happy reading!

If you have any useful suggestions on battling the symptoms please post them or message me! The journey is one – your life is one! No point in wasting it battling the symptoms please enjoy it fully!

[i][i] Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results for the Women’s Health Initiative Randomized controlled trial JAMA 2002;288:321-333

Image Credit: www.slideserve.com

References:

  1. https://journals.lww.com/menopausejournal/pages/default.aspx
  2. https://www.menopausematters.co.uk/index.php
  3. https://bladdermatters.co.uk/content.php?id=155g=0/Influence-of-menopause
  4. http://www.menopause.org/home
  5. http://www.menopause.org/for-women/sexual-health-menopause-online
  6. Grow Your Own HRT Sally J Duffell