Fears about HRT preventing people getting treatment for menopause symptoms, say researchers

Hormone therapy is highly effective in reducing menopause symptoms such as hot flashes and night sweats in up to 90% of patients with moderate to severe symptoms according to an evidence review by Canadian researchers. 

The review, published in the Canadian Medical Association Journal recommends hormone therapy as a “treatment of choice” for people within 10 years of their final menstrual period or younger than 60 years.

The treatment was associated with other benefits including fewer fractures of the hip, spine and other bones, and improved blood lipid levels.

However, the paper ‘A pragmatic approach to the management of menopause’, notes some studies have shown hormone therapy – commonly called hormone replacement therapy, or HRT – can increase risk of breast cancer and stroke, particularly in women older than 60.

“Menopause and perimenopause can be associated with distressing symptoms and reduced quality of life,” writes co-author Dr Iliana Lega, Women’s College Hospital and the University of Toronto.

For people with risk factors, or who prefer not to use hormone therapy, the study identified other treatment options, although noted these were less effective than hormone therapy.

Alternatives included a range of antidepressants, anxiety treatments, chronic pain, blood pressure and muscle relaxant medicines such as serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, gabapentinoids, clonidine and oxybutynin. 

The paper reviews the evidence for diagnosing and treating menopausal symptoms and associated risks and benefits. 

“Although many treatments exist for menopausal symptoms, fears around the risks of menopausal hormone therapy and lack of knowledge regarding treatment options often impede patients from receiving treatment,” write the authors.

According to the paper, the median age of menopause is 51 years. This is often preceded by perimenopause symptoms for up to 10 years before the last menstrual period.

Menopausal and perimenopausal symptoms can negatively impact a person’s mental and physical quality of life.

Symptoms vary and can include hot flashes and night sweats (affecting as many as 80% of women), and sleep disturbance.

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