However, what is HRT and what's the science behind the headlines?
Dr Gareth Nye, a Lecturer at Chester Medical School, who specialises in maternal and fetal health and has expertise in endocrinology (the science of hormones), explains.
What are hormones?
Take a minute to imagine our body is like the UK rail network, with the big cities representing our organs. Our hormones essentially make up some of the trains on the network.
They all go from once place to another at specific times for specific reasons.This could be short distances like between our intestines and stomach, or long distances like our brain to our reproductive tissue.
However, if one of those trains doesn’t run, it can cause chaos across the whole network. And it’s exactly the same with our hormones.
Thankfully, we have a number of drug therapies to replace hormones, but it’s much like putting on a rail replacement bus – it takes time to get things right and, ultimately, you get from A to B, but it’s not perfect.
What is hormone replacement therapy?
There are hundreds of conditions we can develop which are caused by a lack or loss of hormones.
Basically, the term hormone replacement therapy can be attributed to any therapy which aims to replace a hormone that is lower than normal or has left from the body completely.
In theory, this could apply to any hormone disorder like hypothyroidism or type 1 diabetes, but the most common use of hormone replacement therapy is in women experiencing the menopause.
HRT in the treatment of menopause is simply medication to relieve the symptoms caused by a loss of hormones in certain people as they age. This is a natural process in most cases, although it can be brought on through disruption to the reproductive system at an earlier age, such as through chemotherapy.
The most common form of HRT involves taking a combination of the hormones oestrogen and progestogen, although women who do not have a womb can take oestrogen on its own.
Currently 150,000 women have a HRT prescription.
What's going on during the menopause?
During the menopause, the number of eggs left in a woman’s ovaries reduce, meaning there is less need for the hormones responsible for ovulation. With this comes changes across the body and symptoms such as hot flushes or night sweats, mood swings and physiological changes to the vagina. It takes many years for the body to ‘recalibrate’ to this new arrangement of hormones and so HRT can offer relief of specific symptoms during this period.
Studies have shown that more than 80% of women experience symptoms during menopause, yet only 8% will access treatment for it.
What's the benefit of some medication becoming more accessible?
This should really be the tip of the iceberg for women’s health. However, it might not be quite as good as it first seems.
Only one form of HRT is being made available – estradiol - which treats vaginal dryness caused by lack of oestrogen via insertion into the vagina. It is also only being made available to women over 50 who have not had a period for at least 12 months prior.
However, it is the start of removing obstacles to HRT access that will eventually ensure that everyone who should be given this treatment can be in a timely manner.
This may also open to door to women who feel their symptoms are not worthy of a GP visit, or feel uncomfortable discussing it with their doctor.
The main reason only certain forms are being made available is that HRT has associated risks, as with most medications. These include increased risk of breast cancer by up to a third1. and increased risk of blood clots and heart disease 2. These risks are down to the action these hormones normally have outside of ovulation.
Extensive training is being provided for pharmacists to be able to accurately provide the right medication to the right people.
How will this change women’s health?
Hopefully, this move will help to highlight other women’s health concerns and ensure everyone can receive the medication they deserve.
There is a growing concern that women’s issues are being ignored or played down by primary health care providers in some sectors. With the increased awareness and discussion around the menopause, and women’s health in general, this is hopefully becoming a thing of the past.
Endocrinology, women’s health and maternal and fetal health are taught extensively through Chester Medical School. Students are also open to apply for grants at undergraduate level to gain research experience in endocrinology. For more information on our courses visit https://www1.chester.ac.uk/chester-medical-school
References
- Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence Collaborative Group on Hormonal Factors in Breast Cancer (2019)
- NICE guideline [NG23]
