Hormonal Replacement Therapy for Menopause

Stage One

Perimenopause

This stage encompasses the years preceding menopause, whichcan begin in a woman's 40s or sometimes even earlier. It occurs as the store of eggs that a woman is born with declines, leading to lower hormone levels secreted by the follicles in the ovaries. As hormone levels fluctuate, symptoms can appear and disappear, and menstrual patterns change. Common early symptoms include mood changes, anxiety, irritability, brain fog, lack of concentration, and loss of self-esteem, which often precede more recognisable physical symptoms such as hot flushes or night sweats.

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Stage Two

Menopause

The average age for women to reach menopause in the UK is51. Menopause is a retrospective diagnosis and can only be confirmed 12 months after a woman's final period.

At this stage, the ovaries have depleted their supply of eggs, resulting in a significant drop in the three key female hormones: oestrogen, progesterone, and testosterone. Hormone receptors are located throughout the body, including in the brain, skin, bones, heart, musculoskeletal system, joints, urinary tract, and genital area. Fluctuations in hormone levels can therefore impact any or all of these areas, causing a wide range of symptoms.

Early menopause is diagnosed if menopause occurs between the ages of 40 and 45. One percent of women are diagnosed with menopause under the age of 40, known as premature ovarian insufficiency or 'POI'. 1 in 1000 experience it under 30.

Menopause is typically a natural event but can also be induced surgically following the removal of the ovaries, or as a secondary effect of medical treatments such as chemotherapy or radiotherapy.

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Stage Three

Postmenopause

This is the period after a woman’s menstrual cycles have ceased for 12 consecutive months and continues for the rest of her life. GivenWestern life expectancies, many women will spend a third of their lives in post menopause.

While many women may continue to experience menopausal symptoms for four or five years after menopause, the long-term implications of hormone deficiency, particularly on heart, bone, and brain health, will persist throughout their lives.

Menopause in Cancer Survivors

Menopause in cancer patients can be particularly complex, as cancer treatments such as chemotherapy, radiation therapy, and surgery can impact the ovaries and lead to premature menopause or early onset of menopausal symptoms. It is crucial for cancer patients and survivors to access reliable information about menopause and its management.

For women who have had breast cancer, deciding whether to start HRT after treatment is complex, as HRT has been linked to an increased risk of breast cancer recurrence. For women who have had other types of cancer, such as ovarian cancer or endometrial cancer, HRT may be recommended to manage menopausal symptoms, but the timing of starting HRT will depend on individual factors and overall health status.