Menopausal Hormone Therapy

In this episode, leading endocrinologist Dr Christina Jang will walk you through everything you need to know about Menopausal Hormone Therapy (MHT).

Alice from episode 2 joins us again to talk about her menopausal symptoms and how MHT helps to keep her 'on an even keel'.

What is MHT? Is it right for me? Is it safe? What are some alternatives to MHT if I can't have it? Listen to find out.

If you haven't already, please subscribe so you don't miss our final episode, which is all about accessing menopause support and resources.

Featured in this episode

Katie May

Our host Katie is a single mum in her late 30s. She is a communications expert with 17 years’ experience and is passionate about health and wellbeing. She is currently studying Italian just for fun and absolutely adores her pet greyhound, Piper.

Dr Christina Jang

Dr Jang is a Brisbane-based endocrinologist treating all endocrine conditions, with a special interest in female reproductive endocrinology, including menopause. She is a staff specialist in endocrinology at the Royal Brisbane and Women's Hospital (RBWH). She is a senior lecturer at the University of Queensland and president-elect of the Australasian Menopause Society (AMS).

For her, endocrinology is an area of medicine which presents opportunities to deliver far-reaching benefits to her patients.

Alice

Alice is an active healthy and very health-aware 78-year-old concerned about the lack of information for women and their doctors about the stages of the menopause process.

She now has an excellent female GP and is on a low dose of MHT.

She continues to work part time as a speech pathologist and dance movement therapist and enjoys dancing, singing, song writing, writing, improvisation, travel and being a grandmother.

Episode resources

Australasian Menopause Society (AMS)

The AMS is a not-for-profit member-based society aiming to improve the quality of life for women during and after the menopause. The AMS helps women and their health professionals better understand the transition through this stage of life by providing accurate, evidence-based information about premature menopause, perimenopause, menopausal hormone therapy (MHT) and alternatives, osteoporosis and how to locate a doctor interested in women's health. Find out more from AMS.

Jean Hailes for Women's Health

Jean Hailes for Women's Health is a national not-for-profit organisation dedicated to improving women's health across Australia through every life stage. They work in public health, research, clinical services and policy. Their website has practical and easy-to-understand information for women and for health professionals. Visit Jean Hailes for Women's Health for more information.

Lifeline

Lifeline provides free, 24-hour telephone crisis support service in Australia. Counsellors are available to provide mental health support and emotional assistance, not only via telephone but face-to-face and online. Visit Lifeline or call 13 11 14.

Beyond Blue

Beyond Blue is an Australian mental health and wellbeing support organisation. They offer free, qualified mental health support via chat or phone. For more information visit the Beyond Blue website or call them on 1300 22 4636.

Women's Wellbeing Line

The Women’s Wellbeing Line provides free mental health support and therapeutic counselling for women, girls and gender diverse folk in Queensland. For more information visit Women’s Wellbeing Line or call 1800 4WOMEN (1800 496 636).

Transcript

Vox Pop:

It protects me from osteoporosis. It also protects me from being a cranky old bat (laughs).

Katie:

Hello and welcome back to It Can't Hurt to Ask, the podcast where we answer all your health and wellbeing questions.

I'm Katie, and today's episode is all about Menopausal Hormone Therapy or MHT. In today's episode, we're going to debunk the myths and highlight how far this treatment has come in helping women to reclaim their lives.

Joining me again is Brisbane-based endocrinologist Christina, who'll be walking us through everything we need to know about MHT. Welcome back, Christina.

Christina:

Thanks Katie, it’s nice to be here.

Katie:

A quick note on terminology. Throughout this podcast we'll be using the terms women and girls. We use these terms inclusively to mean all people who identify as a woman or girl and recognise that people who do not identify as a woman or girl may still be affected by women's health issues.

Before we get started, we'd like to acknowledge the Traditional Custodians of the land on which this podcast has been recorded. For us it's Meanjin, the land of the Yuggera and Turrbal peoples.

So, Christina, let's start with the basics, again, back to basics. What is Menopausal Hormone Therapy and how does it work?

Christina:

Menopausal Hormone Therapy or MHT are treatments that contain female hormones to replace the hormones that our ovaries would normally be making if we were not menopausal. So, normally that is oestrogen and progesterone, but for women who've had a uterus, they just need oestrogen.

So MHT can be prescribed as tablets, creams, gels or patches.

Katie:

Okay. And what symptoms does MHT help with the most when it comes to menopause?

Christina:

MHT is very effective for hot flushes and sweats, which is the main symptom that women will come and see doctors about. The hot flushes and sweats, which we call the vaso-motor symptoms.

It's also effective for vaginal symptoms and some urinary symptoms, and some women feel some benefit in reducing their mood swings and irritability, sleep disturbance, and some brain fog, if you like, some women find it some benefit, and some memory issues. In the long term, hormone therapy can help with preserving bone density.

Katie:

So I guess, like with every medication, there are side effects. What can women expect if they decide to proceed with MHT, as the side effects?

Christina:

Yeah. So, we always warn women when they start hormone therapy that they can get some breast tenderness. And that's the effect of the oestrogen at the breast. So that usually is pretty mild, and that settles down after a bit of time. And they can also expect some (vaginal) bleeding as well which can be a little bit annoying, but that usually settles down. And if it doesn't settle down there are ways of adjusting the medication or tweaking doses to hopefully help settle that down.

Katie:

Yeah. And how long would it take usually to settle down?

Christina:

Again, that’s a little bit variable from woman to woman. Some women may have no bleeding at all, and for some women it can be persistent and a bit troublesome to manage.

It could take a few months, actually. But usually we get there.

Katie:

Yeah, that's good to know that the side effects are generally pretty low.

In your experience, what's life like between women who take MHT and those who don't?

Christina:

So, for some women, they have no symptoms of the menopause, so they don't need hormone therapy.

Katie:

Lucky them!

Christina:

Yep. Very lucky them.

Some women have really debilitating symptoms, and then we have a discussion with them whether they would like to use some treatments or not. We talk to them about the risks versus the benefits. And most women, after we discuss it with them, would choose to go in for some treatment and the vast majority would come back feeling much better.

The hot flushes are better, they’re sleeping better, and as a result, they're not as tired during the day. Many women report an improvement in their symptoms of the joint aches and pains as well. So, MHT is really very effective.

Katie:

Yeah, that's such a relief to hear that, after everything they experience, there could be, you know, some relief in sight. It’s excellent.

Christina:

It's a good treatment.

Katie:

So, Christina, what about the risks of using MHT?

Christina:

Yeah. Good question. The risks are generally considered very low.

I think several years ago, many women were worried about breast cancer being a risk of MHT, and that all comes down to the study called the Women's Health Initiative, which was released in the early 2000s. And that made that association between breast cancer and Hormone Replacement Therapy (HRT), as it was known then.

So, it's important to know that those women in that study were started at an older age, than we would normally start women on hormone therapy, and they used a lot of older preparations, which we generally don't use these days. So as time has gone on, we've got a lot of information about the risks of breast cancer, and that they’re low.

These days we tend to use the more modern hormone therapies. We refer to them as being ‘body identical’, meaning they would be very similar to the hormones that our ovaries would be producing if they were still functioning.

We also tend to use skin preparations, so preparations which are patches or gels and they don't carry with them a high risk of blood clots. So tablets can do that, because they need to be metabolised by the liver, but gels and patches don't tend to have the associated risk of blood clots. So, many women would be commenced on those first line.

Katie:

Yeah, okay it was good to hear that the treatment has come a long way since that study, and there's a lot more options available to women, which is great.

So, what about women who maybe have tried MHT and it wasn't for them. What are their options?

Christina:

Yes, there's definitely women who we recommend don't use hormone therapy, for example, women who have had emission-dependent or hormone-positive breast cancer, for example. And that's another group of treatments that we use.

So there's a range of medications, traditionally that have been available, including antidepressant type medications, anti-epilepsy type medications, some blood pressure tablets are effective. But there's been a new one that's become available just this year (2024). It was released in America last year and in Australia in February/ March. That one has been very very effective.

So, for many years we've been telling women that their thermostat is broken who have had hot flushes. So the researchers have now worked out what that mechanism is. And so, this new medication targets that very mechanism of the hot flush. And so I've had a bit of experience with it now, and it has been very effective.

Katie:

Yeah. Just with that particular symptom or generally as well for other symptoms?

Christina:

It's mainly for hot flushes, but hot flushes are the most troubling symptom. And that leads to the things like the sleep disturbance and so forth. So, there's a flow in effect.

Katie:

Yeah. Oh that's wonderful to hear - more options.

In a moment we'll hear from Alice from Brisbane, who will speak about her experience with perimenopause and menopause symptoms, and when she first started on MHT.

Alice:

Hi, I'm Alice and I'm a speech pathologist and dance therapist, but also a grandmother, mother.

My periods, which had always been easy, no problem. I had my kids late - I had one at 33 and one at 40. My son, youngest, was six at the time and I started to have severe perimenopausal symptoms.

I would bleed for 13 days and it would be so severe I'd have two super tampons, two super pads, and I would stand up and just flood everywhere. So for the first two days I really couldn't leave the house, which was very awkward. And then I'd have about maybe two weeks off and then it would just happen again. It was a pretty low point.

And then what began to happen was the waking up three times a night, heart going like this (Alice pats chest rapidly), the bed soaked. I would have to get up, change the sheets, have a shower, go back to bed, and that would happen three times a night. So I was getting very little sleep. Then I was getting these attacks of absolute rage.

So I had the full suite of symptoms. Me being me, I looked it all up, I don't think we even had Google at that time, not sure. But, you know, I did find some information. We had books and libraries and things like that, so I had the university library, and a few friends to talk to.

I then rang a friend in Brisbane and said, ‘Get me out of here, can you get me a job?’ So I was offered a job, to start in the next year. So that at least was, I knew I had an exit strategy, so I just focused on them getting through things. And I tried to eat well and take supplements and things.

By the time I got to Brisbane, I knew I'd had my last period. It was about 6 weeks before that, that the bleeding finally stopped, and the friend who'd got me the job in Brisbane, she was going through a very similar thing at a similar age. So, she'd found this lovely GP who was also going through it, and that that GP was absolutely up to the minute with her research. So I immediately started on HRT and regained everything back again.

Katie:

Alice fortunately had a really positive experience on MHT, which she referred to then as HRT. And in fact, she's still on a small dose of the medication to this day.

So let's hear some more about her experiences using MHT.

Alice:

So, and I'm still on HRT, because every time I go off it, I start to get the hot flushes after about three weeks and I'm like, ‘No, that's not going to happen. I'm sorry. Hot flushes in a Queensland summer? Not happening!’

So for years I've been on this, tiny dose, it's one 300 milligram tablet twice a week. The normal dose would be, I think, 600 a day, so that's just enough to keep me on an even keel.

And, you know, we have modern medicine. If it can create a synthetic hormone that works, why mess about, you know? And it's protecting me from bowel cancer, which is what my father died of, got a 1 in 9 chance of that. It protects me from osteoporosis, lots of old ladies get that, and a few other things. But anyway, it also protects me from being a cranky old bat who can’t remember anything!

Katie:

So, what did you think about Alice's story there, Christina?

Christina:

I thought it was really positive. I thought she was really very articulate in the way that she described her symptoms. I thought she found herself a group, like a GP, a friend - they were both going through a similar experience, so that provided some support for her.

I really like the way that she embraced the concept of using some hormone therapy when it was given to her. She's obviously done quite a lot of a lot of reading about it. She's aware of the positives. So I think she's done really well.

Hormone therapy is an excellent treatment for the symptoms of menopause. Many women benefit from it. It's not for everyone, though. It's a really good idea to have a chat to your doctor and see whether it's appropriate for you. All treatment, like hormone therapy, should be tailored to the individual, and really really emphasise that.

Katie:

I think it'll be great just for our listeners to hear that there is something out there that can potentially help them. That's really important to hear.

Christina:

Definitely.

Katie:

We’ve spoken about everything under the menopause umbrella, from mental health, MHT to sex. So what’s next?

Well, what kind of support and resources are available to women and people going through menopause? Plus, what can we do to support those going through menopause?

We’ll be discussing all this and more in next week’s episode, so don’t forget to subscribe and leave a review.

And thank you again to Christina for joining us, and to the team at Queensland Health for making this podcast possible. See you next time on It Can't Hurt To Ask.