Understanding and acknowledging the real physiological changes
by Neale Watson, Consultant Gynaecologist
Getting HRT right
The menopause is the time in a woman’s life, usually after the age of 45, when she stops having periods. This is because the production of the hormones oestrogen and progesterone stops. The menopause is considered a normal life event for women, however, I believe that in some ways we are getting the menopause completely wrong. In the years leading up to the menopause (perimenopause) the level of hormones produced by the ovaries, and in particular oestrogen, starts to decline, which brings about a number of real changes to a woman’s body. The alteration in ovarian function with loss of cyclic hormonal activity causes definite metabolic affects. As doctors, we need to be careful to separate out post-menopausal endocrine changes from those you would expect to see with the normal ageing process found in both men and women.
The role of oestrogen
The hormone oestrogen is extremely important within the female body and it affects many aspects of health. As a consequence, when it diminishes there are profound impacts on health.
Brain health and menopause
Women’s ability to concentrate, as well as general mood are significantly affected by the changes that take place during menopause. This is because oestrogen affects the release of the neuro-transmitters dopamine and serotonin – both of which play a key part in regulating mood. As a consequence, declining levels of oestrogen often results in low or fluctuating moods. In addition, there have been good quality studies, with placebo controls, that have shown that mental agility can be improved when women are given oestrogen. Unfortunately, women are frequently given antidepressants which worsen their symptoms. Research in 2019 reported that over a third of women going to their GP with symptoms of the menopause were offered antidepressants. In our clinic, we have seen countless cases of women’s depression that has been successfully alleviated by the correct dosage of hormone replacement.
Heart health and menopause
We know that women have an increased risk of heart attacks after the menopause, however, we also know that HRT can offer protection against coronary artery disease. Some studies have indicated that it can reduce the chance of having a heart attack by up to 50%. Research from the USA has also found that women taking HRT less than six years after the menopause had slower artery wall thickening than those taking a placebo. It is worth noting that there is some evidence that HRT is associated with an increased risk of deep vein thrombosis (DVT), but the science behind this has been rather distorted. In fact, HRT tablets are linked with a higher risk of developing a blood clot, but not patches or gels.
Bone health and the menopause
Oestrogen helps to protect bone strength and therefore during and after the menopause there is a risk of decreased bone density, which can lead to osteoporosis and fractures. Unfortunately, it is difficult to tell which women are going to be at risk of this although we do know that women with smaller body frames from white or Asian descent are more likely to have osteoporosis. However, osteoporosis can be detected by DEXA scanning. Naturally, osteoporosis is best avoided in the first place if at all possible and HRT can help with this.
Consultant Gynaecologist, Neale Watson says that although treating the debilitating symptoms of menopause is extremely important it is also key to understand and acknowledge the real physiological changes brought about by decreasing hormone levels that take place during and after the menopause. We must therefore be proactive in ensuring that women have access to the most expert care.