Hormone replacement therapy (HRT) for premature menopause

Written in association with:

Endocrinologist

Published: 20/03/2019
Edited by: Lisa Heffernan

For most women, the menopause starts between the ages of 45 and 55, however sometimes the menopause can arrive sooner. The menopause is that point in a woman’s life when a woman’s oestrogen levels decline, periods stop, and a woman is no longer able to have a natural pregnancy.

Premature menopause (before the age of 40) and early menopause (before the age of 45), whether spontaneous or induced by surgery, chemotherapy or radiotherapy are associated with significant long-term health risks.

These health risks include:

Cardiovascular disease (heart attack or stroke) Osteoporosis Neurological diseases Mood disorders Psychosexual dysfunction Premature death

The age of onset of a lack of oestrogen is the most important factor in determining long-term health. The younger the woman is at the time of being diagnosed with premature menopause, the greater the risk of all of the above-mentioned disorders.

We asked Professor Gordana Prelevic, leading consultant endocrinologist, to tell us how women can reduce health risks associated with premature menopause with the use of hormone replacement therapy.

What can be done to reduce the health risks of premature menopause?

Oestrogen replacement can mitigate some long-term health risks. HRT or hormone replacement therapy is therefore strongly advised for women with premature menopause for long-term use up until the normal age of menopause, which is about 50 to 51 years. There is some evidence that restoring low oestrogen levels will reduce the later development of cardiovascular diseases such as osteoporosis and possibly dementia.

Your doctor can also advise you to make lifestyle changes to help protect your health, like taking calcium supplements to help keep your bones strong and dietary changes to keep your heart healthy.

The benefits of HRT for premature menopause

Many women find that after a few months of hormone replacement therapy, symptoms of the menopause like night sweats, hot flushes and mood swings improve, and energy levels increase. As well as improving symptoms, HRT reduces your risk of developing the health risks associated with premature menopause as mentioned before.

Risk of cardiovascular disease is reduced and HRT can help to lower cholesterol. Bone loss can be prevented, reducing your risk of osteoporosis which is associated with reduced levels of oestrogen. The risk of developing Alzheimer’s disease is lowered.

Are there risks with HRT?

Some women might fear that long-term use of HRT increases the risk of breast cancer. It is well-known that women with premature menopause have a decreased risk of breast cancer. Therefore, a well-balanced standard HRT dose is not expected to increase the risk of breast cancer, at least up to the age of 50. If the ovaries had continued to function, women would be exposed to much higher levels of oestrogen and progesterone than those present in standard HRT.

Along with risks, sometimes women might experience negative side effects with HRT, like skin irritation with gel patches or leg cramps which subside after a few weeks. The delivery method can be changed if side effects persist.