Hormone-based medications for early menopause: Women’s knowledge and perspectives

Hormone-based therapies for early menopause (EM) include oestrogen-based therapies (Hormone Replacement Therapy – also known as Menopause Hormone Therapy – hormonal contraception), and testosterone (androgen) therapy. These therapies work differently and therefore suit women in different circumstances, but they can ease the symptoms of EM. Oestrogen-based therapies may help reduce long-term health risks such as osteoporosis and heart disease.

Women with EM able to take HRT are advised to do so until at least age 50, unless they have experienced oestrogen sensitive cancer (e.g. breast and endometrial) (see Non-hormone based medications for early menopause). Findings from studies of HRT in older post-menopausal women may not necessarily apply to women with EM, especially under age 50. For more information, see the Box at the end of this Talking Point.

Benefits and risks of HRT: What women knew

Women’s knowledge about the benefits and risks of HRT varied. Some were well-informed; others less so. Jessica, who had experienced relatively few menopausal symptoms and whose GP had not suggested HRT, admitted: ‘I don’t know what HRT is, to be honest.’ Symptom relief, and protection against osteoporosis and heart disease were the main reasons women gave for taking oestrogen-based therapies. A couple of women were not aware of the benefits for bone health, and very few mentioned the protective effects of HRT on heart health.

Melinda described what her endocrinologist had told her about the benefits and risks of HRT.

Making sense of information about HRT

Several women commented that ‘confusing’ information and new research findings they had encountered about HRT had meant they were unsure about the risks, whether or not to take HRT, or for how long. As Ella said: ‘I’m not sure, the whole thing with heart health… I can’t understand whether HRT’s good for your heart or not because of the different studies.’

While some women received helpful information and advice about HRT from health practitioners, others were not satisfied with the information they received. Tracey, who had a risk reducing BSO after being diagnosed with Lynch Syndrome, recalled talking to her gynae-oncologist about HRT beforehand: ‘He basically asked if I was on the pill and [said], “[HRT] is similar to that, you just keeping taking your pill every day.” He didn’t really talk to me about what that meant and what the symptoms were or how to manage it or anything like that.’

Debra ’s gynaecologist provided her with ‘lots of’ information about HRT, but she still felt that making an informed choice was difficult.

HRT and genetic predisposition to increased cancer risk: Women’s views

Women who carried genes pre-disposing them to cancer (e.g. BRCA1/2 or Lynch Syndrome) varied in how they felt about HRT. Tracey felt comfortable taking HRT. In contrast Lydia, who had a risk-reducing BSO after discovering she had the BRCA gene, had decided not to take systemic HRT (which affects the whole body). Despite her doctor’s assurances of its safety, she was worried about increasing her cancer risk, attributing these fears to experiencing several close family members die from cancer. She said she struggled with using even vaginal oestrogen regularly: ‘I don’t know, I think I just have issues with oestrogen-based things.’

Kirsty had been diagnosed with both POI and the BRCA 2 gene mutation. She was initially told she could not take HRT, but five years later the research changed and she began taking it.

Not taking HRT

A couple of women delayed starting or avoided taking HRT because they wanted to avoid medication and instead try to manage their symptoms through diet, exercise or complementary and alternative medicines (see Complementary medicines and alternative therapies for early menopause and Lifestyle changes to help manage early menopause. Note that current recommendations are that women with EM take HRT until age 50 unless they have experienced hormone sensitive cancer).

Theresa explained her reasons for waiting two years after having a risk-reducing BSO before starting HRT.

The Women’s Health Initiative

Publication of two large clinical trials (the Women’s Health Initiative) in 2002 and 2004 has led to confusion about the risks and benefits of HRT. Women involved in these trials were on average 63 years old and only HRT in tablet form was used. Findings from these studies do not necessarily apply to women with EM, especially under age 50. Risks and benefits of taking HRT are individualised to each woman and depend on her age, cause of EM, type and duration of HRT preparation, and other health issues. What form of HRT suits one woman will not necessarily suit another. See also Hormone-based medications for early menopause (Health Practitioners’ perspectives).

Further information:

Talking Points (Women)

Talking Points (Health Practitioners)

Other resources