Menopause is a naturally occurring transitional period for women, usually occurring at the mean age of 50 years and 9 months for women in the UK, as a result of ovarian follicular activity ceasing, after which, reproduction can no longer take place . The transition period from reproductive life into non-reproductive life, is known as perimenopause. This is a stage of strong fluctuations in estradiol, also known as oestrogen, and progesterone, the sex hormones, resulting in both physical and psychological symptoms that can affect a woman’s quality of life . The average timespan of menopause transition, going from reproductive to perimenopause through to post menopause, the stage where periods have ceased for more than 12 months, can be from 4 years upwards.

During these transitional stages, symptoms such as hot flushes, sleep disturbances, night sweats and vaginal dryness are all commonly reported, with symptoms lasting 4-5 years . Other symptoms can include fatigue, depression, memory loss, headaches, joint pains, sexual dysfunction, and weight gain all of which can have a big impact on a women’s quality of life and career.

One of the most prescribed treatments for menopause symptoms is Hormone Replacement Therapy (HRT) such as estradiol and progestogen, which is made up of conjugated equine oestrogens, effective in relieving moderate to severe vasomotor symptoms. However, concerns arose surrounding HRT after the Collaborative Group on Hormonal Factors (CG) (1997) study, found that the risk of breast cancer increases with use of HRT. Subsequently, the Writing Group for the Women’s Health Initiative Investigators (WHI) (2002) who originally planned to study the benefits and risks of HRT using estradiol and progestin, the synthetic form of progestogen, using a randomised controlled trial of 16608 women, stopped the trial after 5 years due to concerns arising around an increased risk of developing breast cancer. It was determined that the risk outweighed the benefits, and therefore the study was discontinued.

The Million Women Study Collaborators (MWS) (2003) reaffirmed these results after finding a significantly increased risk of fatal breast cancer with combined HRT. Not only does HRT pose a significant risk to breast cancer, but also to cardiovascular events as a result of HRT causing C-reactive proteins levels to increase, leading to increased inflammation in women taking oral HRT, including pulmonary embolism, stroke and coronary heart disease. As a result, many clinicians stopped prescribing HRT and some women, already prescribed HRT, discontinued taking it. Since then, there has been an increased interest in alternative hormone treatments for menopause symptoms (which we will look at separately), however, to this day, HRT still remains the most effective treatment of menopause symptoms.

Considering this, Pines et al., 2008 after considering the findings from the Women’s Health Institute in 2002, discovered that the negative slant adopted as a result of the early termination of this trial, does not reflect the positive results of HRT recorded for healthy women in early post menopause, which showed that HRT is safe for healthy women at this stage of menopause. Additionally, Caufriez in 2007 found that the risks associated with HRT were higher with oral estrogen and progestin compounds, but relatively safe in most post menopausal women with a combination of transdermal estradiol and micronized progesterone.

Therefore, this decision is not one to be taken lightly, it involves discussions with your GP and should include any previous history (including family history) of cancers and the types of HRT currently available, weighed up against the impact of symptoms themselves.