Wellbeing champion | Evolving the menopause discussion: Difficult HRT decisions

Evolving the menopause discussion: Difficult HRT decisions

By Tracey Ward, Head of Business Development & Marketing at Generali UK Employee Benefits

Workplace activity to inform and educate about menopause should arguably also include a focus on difficult Hormone Replacement Therapy (HRT) decisions, according to the experts we spoke to as part of a recent webinar.

Because, in spite of Davina McCall’s best efforts to highlight evidence that long-held links between HRT and breast cancer might not be as watertight as previously believed (more on this later), the decision about whether or not to take HRT, remains tough for many. And not only for those with a history of breast cancer, but also for women with other potential complications, such as being on long-term medication.

We recently brought together experts to provide us with their wisdom on this topic; from what is HRT, whether it is safe and when should you start taking it, to considerations when you have potential complications. This article includes some of the highlights of this webinar.*

Menopause continues to be a hot topic in HR media. Recent news articles include the fact that women will be able to access HRT more cheaply now (as at 1 April 2023) by using a new prescription payment certificate. It was also announced recently that the government has appointed England’s first menopause employment champion, tasked with helping employers improve workplace support.

However, HRT supply issues have also dogged the headlines, and although most types now appear to be in stock, access to some remains problematic. There was a huge 35% increase in prescriptions for HRT in 2021, according to a report from the NHS Business Services Authority, reported in Pulse. Whether or not this can be attributed to Davina McCall’s influence, with her Channel 4 documentary in May 2021 – and ongoing campaign work – it does seem that midlife taboos are being lifted, long-held beliefs questioned and more people turning to HRT.

So, zooming in on the burning question for the purposes of this article, is HRT safe?

Dr Lucy Wilkinson, a GP at Teladoc Health – Generali UK’s virtual GP and second medical opinion partner - has a special interest in women’s health and health-tech. She says that the British Menopause Society, of which she is a member, currently states that HRT is generally safe for most people. However, there are certain exceptions to that, so it’s important for women to speak with their own GP and find the lowest risk form of HRT that would work for them.

“For most people that is called transdermal HRT; the kind of HRT that’s applied to the skin and absorbed into the bloodstream, before being distributed around the body. This can be given as patches, gels or sprays.

“HRT was originally taken as tablets but we know now that this is slightly higher risk, especially for blood clots. In contrast, the lowest risk form of HRT is called vaginal HRT and is used to treat vaginal symptoms or bladder symptoms. This is low risk because the hormones that we use just stay in the one part of the body; the genital area.

“However, risk is a very individual thing. The best place to start is by speaking to your own doctor. They will be able to tell you about the safest options for your personal circumstances. It could be that HRT isn’t an option for you, in which case it’s not the end of the world; there are other non-hormonal treatments and measures that you can take as well.”

Anxiety about HRT can be tracked back to studies in the US and UK in the 1990s, which identified safety issues (“a small increased risk of breast cancer, heart disease, stroke and blood clots”) with combined HRT. This led to a high level of media interest and scare headlines, followed by doctors advising patients to come off HRT. A follow-up study focused on oestrogen-only HRT and found a small increase in the risk of breast cancer, less than the risk for combined HRT. The longer HRT was used, in both cases, the higher the risk.

Shortcomings have subsequently been identified in both the US and UK studies, related to various associated risk factors that weren’t taken into account at the time, namely that some women were much older than others, the majority were overweight, some were already having a mammogram, so might have already suspected a lump.

Anxieties remain though. But these anxieties shouldn’t preclude women from seeking advice from the experts on their individual circumstances.

“Don’t be afraid to say to your medical practitioner that you don’t understand if you’re still not sure about the risks,” adds Dr Julie Denning, Chartered Health Psychologist at Working To Wellbeing; Generali UK’s Vocational Rehabilitation partner. Working to Wellbeing can provide coaching support for women going through the menopause to help them with coping techniques and self-management. “Just ask, can you explain that to me in another way? It’s really hard to understand data and information when you’re struggling with cognitive difficulties caused by the menopause, so definitely ask questions. In fact, go into your consultation with a list.”

*To access a free recording of the full 30-min webinar ‘Menopause & difficult HRT decisions, please email [email protected].

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All information contained herein represents the views and opinions of the author as at the date of writing and is provided for general information only. Nothing herein constitutes or is intended to constitute financial or other form of advice and no individual should rely upon the information provided in making a specific investment decision without first seeking independent professional advice.

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