Navigating perimenopause can be a confusing and overwhelming experience, especially with the flood of information—and misinformation—there is online about treatment options. In this blog, we’ll explore Hormone Replacement Therapy (HRT) - and why it's now actually referred to as MHT. We’ll also delve into the debate between bioidentical hormones and traditional MHT, the importance of checking hormone levels, and alternative options for symptom management. Finally, we’ll guide you on finding the right healthcare professional to support you through this transitional phase.
HRT versus MHT
You have probably heard the term HRT (Hormonal Replacement Therapy) before - but did you know that it is now more correctly referred to as MHT (Menopause Hormone Therapy)?
Searching online for information about MHT can be a minefield, and a Women's Health GP can be a really good option as a trusted health professional to cut through the misinformation and give you the facts.
Below are some very common questions and concerns about MHT and other management options for symptoms of peri-menopause, written by a Women's Health GP.
Should I consider going on MHT for perimenopause symptoms? Or is that too 'risky'?
Menopause hormone therapy is a very effective option for managing common menopause symptoms when they interfere with your life.
All medications carry some degree of risk, which depends on many factors including;
- The type of medication
- The dosage
- How long the medication is used for
- The formulation (e.g. tablets, vs patches vs gels)
- Your personal medical history and family history
This then is balanced against the expected benefits of treatment. MHT is considered suitable if the expected benefits outweigh the potential risks, which is the case for the vast majority of women experiencing perimenopause.
A health professional such as a GP with an interest in women’s health is trained to assess your own personal risks and benefits and help you to make an informed decision as to whether MHT is right for you.
What's the difference between Bioidentical Hormones and traditional MHT? Which is better for me?
“Bioidentical hormone” is a term used to refer to the use of hormones that are structurally identical to those naturally produced by the human body. These are often marketed as a more “natural” option for hormone therapy, and are often compounded into formulations such as creams, lozenges/troches and pessaries which are then used for menopause management.
It’s important to know, that just because these formulations are “bioidentical”, they are still made in a laboratory and are not necessarily any more “natural” than traditional preparations. Additionally, the dosages and components can vary and there is little regulation in their use and preparation - the biggest problem with this is that a woman may not receive an adequate dosage of progesterone to protect her uterus (womb) when using oestrogen (oestrogen used on it’s own, or with an inadequate dose of progesterone can increase the risk of cancer of the uterus!). There is no evidence that these compounded preparations are any more effective than traditional formulations.
Traditional formulations have been tested for safety and efficacy. Additionally, there are several licensed formulations available now that actually contain bioidentical hormones! - in dosages that have been studied and are safe to use.
At FitRight HQ we advocate for safe and informed use of MHT and the use of licensed formulations. Bioidentical hormones may be a good option for you, but we advise against the use of unregulated compounded preparations.
I may be perimenopausal - Should I have my hormone levels checked?
The routine checking of hormone levels is not routinely recommended in perimenopause/menopause. This may surprise you, but perimenopause is a clinical diagnosis - which means we decide if you are in perimenopause or postmenopausal based on;
- Your age
- Your symptoms
- Ruling out other conditions that could cause your symptoms (we will often check thyroid levels, for example!)
Hormone levels in perimenopause can fluctuate quite a lot, and are not actually all that useful in our management. In some cases, however, it may appropriate for us to check your hormones, for example when;
- We are suspecting premature menopause (aka premature ovarian insufficiency) in someone under the age of 40
- We suspect another condition such as polycystic ovarian syndrome (PCOS)
- We are wanting to assess your need for ongoing contraception
Additionally, routine monitoring of hormone levels if you are using MHT is not usually required, except in some select circumstances.
What if I don’t want MHT? Do I have other options with good evidence for symptom management?
Many women prefer not to use MHT, or are unable to due to medical reasons. Fortunately we do have several other options that can help with the management of several symptoms, including several prescription medications that are not hormone based.
Additionally, lifestyle management factors such as identifying and avoiding triggers for hot flushes, temperature regulation, maining good nutrition, exercising, stress management, mindfulness therapy and sleep hygiene (just to name a few!) are an important component in the management in perimenopause, regardless of whether MHT or other medications are used.
Who will be the best kind of health professional to help me with my symptoms of perimenopause?
Many different types of health professionals may be of help, depending on what your symptoms are and what is troubling you the most. A good starting point is to see a GP with an interest in women’s health for an initial assessment. They will be able to suggest other health professionals that may be able to help with specific symptoms, help you to make a decision around MHT or alternative medications and co-ordinate the whole management of your perimenopausal symptoms.
At FitRight HQ our GPs are experienced in the management of perimenopause and menopause and are available for consultation. They can provide comprehensive management of your perimenopause or menopause symptoms, or provide a “second opinion”, depending on what level of input suits you best.
Written by Dr Brodie Thorpe on behalf of the FitRight Women's Health GP services.
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