What you need to know before speaking to your doctor about menopause and HRT

With menopause care being hit and miss depending on the training your GP or gynaecologist has had, arming yourself with information has never been so important. Here are a few important points you need to know to challenge the misconceptions in menopause care.

If your 45 or over you don’t need blood tests. 

Blood results to diagnose menopause or perimenopause are unreliable as hormones fluctuate in the early stages. A blood test is just a snapshot in time of what is happening and doesn’t reveal the whole picture. The NICE guidelines say that if you if you are over 45, menopause can be diagnosed by the clinical symptoms, without the need for blood tests. Blood tests may still be done to rule out other conditions that could be causing your symptoms.

If you’re still having periods you can still receive HRT. 

You don’t have to have stopped your periods before seeking help or treatment. In perimenopause your periods will often become irregular or sometimes heavier before they stop, and symptoms are often the worst in perimenopause. Cyclical HRT is prescribed when you are still having periods, and continuous HRT after your periods have stopped for a year.

If someone in your family has had breast cancer, you may still be able to have HRT. 

This is a common misconception amongst patients and clinicians. Women with a family history of breast cancer need a thorough assessment to look at their risks. If, for example, you have one family member who had breast cancer over the age of 40, you can usually still have HRT. Your clinician will talk to you about how to bring down your risk through modifying lifestyle, and prescribe the safest form of HRT. Women who have multiple relatives diagnosed with breast cancer, or relatives who were diagnosed earlier than age 40, need a referral to genetics clinic before they can decide on the safety of HRT.

If you have had a blood clot or someone in your family has, you can still have HRT. However, you should only have it through the skin (transdermal HRT). 

Transdermal HRT (gel or a patch) enters the bloodstream by bypassing the stomach and liver. Unlike oral HRT, it does not activate clotting factors in the liver, and has no increased risk of a blood clot.

If you have high blood pressure, diabetes, migraines, are overweight or a smoker you should have HRT via a patch or gel. 

Transdermal HRT (patch or gel) is safer in this group of women as it has a lower risk of stroke.

Body identical HRT has the same molecular structure as a woman’s hormones. 

For women who are worried about risk factors (eg. family history of breast cancer, or are overweight) body identical HRT is the safest form of HRT. The oestrogen that comes in most forms of modern HRT is body identical, and Utrogestan (micronized progesterone) is the body identical form of progesterone.


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