Menopausal Hormone Therapy (MHT). What is it, what are the risks, what are the benefits, what are the alternatives, what did I experience?  

For me MHT was a game changer. I mean it literally worked within a couple days to relive some of the symptoms I was experiencing, in particular the anxiety, depression, moodiness and lethargy. It was such an immediate improvement, that upon arriving home from a business lunch my husband reprimanded “Megan you can’t drive like that!”. Me, “like what?”. Stephen, “You can’t drive when you are drunk, just take an Uber!”. Well, here is the thing, firstly I don’t drink and drive, but I was not drunk, I hadn’t even been drinking and yet for the first time in months I was smiling, wanting to chat with my husband and just generally feeling giddy! When my husband questioned further, what on earth was going on? I clarified that it must be the patches! And you know what, it was. But my experience of MHT is not straight forward and like many women who choose this path I needed tweaks, adjustments, and modifications to get it right.

MHT is the medical replacement of female hormones oestrogen and progesterone, and sometimes testosterone, all of which play different roles, and which change as we enter the Meno phase. MHT is said to be the most effective way to control your symptoms and at the same time it can help us with other aspects of our health, such as reducing the risk of osteoporosis, heart disease, fractures, some cancers, diabetes, dementia and even cataracts.

In general estrogen is the main hormone prescribed for MHT and relief of Meno symptoms because it acts by replacing the estrogen we are losing, and it is delivered in similar levels that we would have been producing naturally prior to Meno. If you are like me and have a uterus, we need to have both estrogen and progestogen, because there is a risk that on its own estrogen could overstimulate the cells lining our uterus and cause an increased risk of cancer to the uterus.  So, with the two hormone powers combined, progestogen with estrogen, our risk of this is minimised. MHT comes in many forms it could be a tablet, patch, gel, or vaginal treatment.

Some women prefer not to have, or are unable to have a hormonal treatment, in which case the options include the use of off label treatments, like antidepressants, Gabapentin or Clonidine. By off label it means the drug is being used for a purpose not specifically approved by the TGA. Going down this path will usually address the hot flushes and sweats and they generally take effect in 4 weeks.

Then there are complementary medicines and therapies (CMT), which come in many, many, many different forms, and are generally founded in traditional natural medicine practices (such as Ayurvedic, Chinese and Unani Tibb) some, but not all of these treatments are backed up by scientific evidence. Most commonly you will have heard about Black Cohosh, Red Clover, Dong Quai, and Evening Primrose. You might be familiar with horny goat weed, lemon balm, valerian, or lavender. But there is a whole raft of other things in this category, pre and pro biotics, salts, and fish oils too.

When starting on the MHT journey, numerous friends warned me about the risks of breast cancer and asked if I should be taking MHT, “what was I doing?”, “do I have this type of cancer in my family?”, “Be careful!”. I believe that this response to my decision is because the original report from 2002, by the Women’s Health Initiative (WHI) found a slight increase in breast cancer risk, as well as an increased risk of heart disease, blood clots, and stroke for women on oestrogen therapy. This treatment has since been grossly underused in healthy women in their 40s and 50s who could have really benefited from its use. This misunderstanding of MHT needs to be reframed in our collective minds, because 20 years on, the research by WHI and others that found similar data, have been thoroughly reviewed and what has become apparent is that MHT is an effective and safe treatment to relieve Meno symptoms if you are considered healthy. Further the review demonstrated that MHT had low risks for women in their 50s and 60s, or when used within 10 years of your final period and it actually improved outcomes for health when starting in your 40s.

There are many factors to consider when deciding to go on MHT and it is obvious that more research is required to understand how MHT and CMT might impact other health conditions, but your Doctor will discuss all of this with you and assess your symptoms and risk factors. Personally, after many years of suffering, being misdiagnosed, and with my symptoms intensifying, I had no hesitation in getting on the MHT train. I wanted some normality back! So here is what happened for me……………

I started on Estradot® 100 mg/24 hoursand Prometrium® 100mg. Estradot® is the oestradiol hormone (oestrogen) and Prometrium® is simply the progesterone hormone. Both are ‘body-identical’, meaning they contain the identical hormone produced in our body. This was a factor in my decision making, as I did not want to use any synthetic hormones.

As I said above, the positive impact on my mental health and moodiness was almost immediate and this helped me to breathe through some of the not so pleasant side effects. Within a week my boobs started aching. I was warned by my prescribing gynaecologist, but I was not ready. They really hurt! Then my boobs started expanding and the funny thing is (in hindsight) all I ever wanted was bigger boobs! My whole life I have been almost flat chested, and I dreamed of having a full C cup. Well, when I went from just being a B cup on a good day to a C cup in a matter of weeks, it was not pleasant. This did settle down, just as I was told it would, but I have never been able to go back to underwire bras. I just can’t wear them anymore. I did initially have some weight gain and the feeling of being more bloated than normal, but I felt like I could work with those things, they were very mild and the other benefits I was feeling made it all worth it.

One of the other reasons I started on MHT was to get my bleeding under control. My bleeding was basically 2 weekly and more frequently at times and it was so heavy it could be debilitating. There were days that I needed multiple showers, so I have to admit, working from home was a real advantage, I can’t think how I would have managed in an office. When I started discussing how to control my bleeding, I was given the opportunity to have a Mirena. Mirena’s sound great for lots of women with this symptom (and who are looking for contraception) and I know several women who swear by this option. The Mirena is a hormonal IUD and is a ‘T- shaped’ plastic device inserted into the uterus, with a coating of a synthetic progesterone that slow releases. The only reason that I did not go with this treatment was I was worried about it being inserted (as I have never given birth). The other treatment I was asked to consider was an endometrial ablation and this is where through day surgery under aesthetic, a loop of wire heated by electricity is inserted to remove the lining of your uterus and any polyps or small fibroids. The goal of endometrial ablation is to reduce flow and if you are lucky this procedure may stop you bleeding altogether, that was certainly the case for a friend of mine and some others I have heard about. However, when I was initially offered this, my dad had stuff going on, and I became occupied with that and by the time it came around to discussing this option again I made the decision not to risk a surgery, as COVID was still in play.

So, the MHT combination I was on did help a lot, but I was still having break through bleeding, struggling with brain fog, low libido, and lack of energy, due to lack of sleep and night sweats. Being someone who has never been on any medication or who wasn’t taking any supplements it was a lot to coordinate the taking of the pills at the right time of day and remembering to change the patch and make sure the patch was on properly. I had started the Meloxicam around the same time for my body pain, so also had that in the mix. I had several post-it notes around the house as well as reminders in my phone. I didn’t want to give up though, as I was only 3 months in!

Then in the 5th month I had a particularly dark moment. I simply felt off that week and on and off for about a month leading up to this. By the Saturday I really felt out of sorts. I had breakthrough bleeding again (!) and by the time we had dinner I was sobbing, for no reason. I actually had a great week and a good day, but I was so sad, and the dark thoughts were running circles around me. I went to bed at 7:30pm and cried myself to sleep. I woke up the next morning, having had a restless, hot sleep, on a wet pillow, still sobbing. WTF! Seriously that was my first thought. So, I got up and went for an early morning 45km bike ride, crying the whole way, I must have looked a treat! I got home, my husband was up, and he immediately worried something had happened to me on my ride. It hadn’t, but in my haste and embarrassment to try and get in the bathroom, so I could really howl in the shower, I accidently slammed a door (this is a first in my whole life) and so then my husband thought he had done something. He hadn’t. Undressing to get in the shower I realised that my patch was not on correctly and then I couldn’t remember if I had changed it that week. For goodness’ sake it was too much! I was a total hysterical mess. I felt like I gave this MHT version a good crack, so I made an appointment to see what other options there were. I switched immediately to QLAIRA®.

Qlaira® is a combined oral contraceptive, commonly known as “the Pill”, and is generally used to prevent pregnancy. It is used for the treatment of heavy and/or prolonged menstrual bleeding (not caused by any underlying disease) and it is now being used in the treatment of Peri-Meno, because of the similarities that exist between products used for contraception and those used as traditional MHT, and if like me you thought you were finished with the Pill (my husband and I can not medically have children) then think again. One of the advantages of the pill, is that it provides both relief of Peri-Meno symptoms and gives contraceptive protection at the same time.

This is not widely discussed, however many middle-aged women who are sexually active, still run the risk of getting pregnant and studies have shown that middle-aged women (like teenagers) have a higher-than-average proportion of pregnancies that end in an abortion. This stage of life has so many emotional edges and can be extremely sensitive in terms of procreation. For some of us it is liberating, while for others, the end of reproductive possibilities, can be very distressing. But it is really important to understand that while you are going through the Peri-Meno rollercoaster, you are still fertile. So contraceptive protection is required if you do not want an unexpected pregnancy.

My experience of Qlaira® has been a positive one so far. I have had a significant improvement in my symptoms, I feel much better mentally and while I am still not having totally monthly bleeding, the flow is much, much, much less than it was, and I am overjoyed about that! I feel like the rollercoaster I was on, with really extreme peaks and troughs has certainly smoothed out. But! This did not stop the night sweats or insomnia (I was changing sheets up to 3 times a week) and I was becoming increasing constipated and bloated, my brain fog was not subsiding and while I had a bit more energy, I was still flat. So, I started to look into what else it could be and what else I could do, what did I need to modify further to get the outcome I was looking for?

The brain fog, lack of sleep and night sweats were distressing. Like most women I have a lot to coordinate in my life, I have a full-time day job that requires attention to detail and the ability to put sentences together, quickly! I have family commitments and you may have worked out by now; in my “spare time” I have been starting Positively Charged. I needed to be switched on and I felt like there was a problem with my starter switch, I wasn’t firing, and I wasn’t shining brightly!

I started looking for some more answers and that is when I stumbled across 40-page report from The Lucy Rose Clinic (TLRC) ‘Fixing Your Hormones After 40…. Menopausal symptoms don’t have to be the norm’. Excellent I thought! I read this twice over and that is what made look more deeply into Iodine and Cortisol and my thyroid! I initially reached out to a friend who is a naturopath in Adelaide, but not being able to get into her for several months, I booked with TLRC. This is when, with complementary supplements and addressing my underlying imbalances, I did actually notice a turnaround in all of my symptoms. However, to get to this point, I did have to undertake a functional health test, which is an in-depth functional thyroid and hormonal test to find the underlying cause of symptoms. This was not covered by Medicare, and neither is any naturopathy or any of their supplements. This is something that needs to change in my opinion. More on that in another Meno Journal!

Now here I am writing this, around 12 months after my MHT journey started, and after my last gynaecologist appointment, and sharing the results of my ‘functional heath test’ from TLRC with her and despite my own (husbands, families and friends) observations that I am feeling much improved with the MHT and CMT; I have now been referred to see an endocrinologist, who is a medical specialist for a range of conditions that are caused by problems with hormones, such as menopause and thyroid problems. I will let you know how I get on with that process another time, because I am on a waiting list of 8 months, but my neighbour managed to get into someone sooner and discovered that in fact the condition she thought she did have, is actually something else. My goodness it is a process!

In summary, MHT is safe if you are considered healthy, so if you are at any stage of Meno then this could be an option to assist you with your symptoms. MHT comes in many forms it could be a tablet, patch, gel, or vaginal treatment. There are also non-hormonal treatment options, modifications you can make to your life and of course complementary therapies.  I am learning everyday about my body and how it functions, and I am also learning that the more you talk about this with other women the more you realise that we are unique and so are each of our experiences during the Meno phase. The most important thing about talking is that you start to discover it is usually a combination of things that is required to get on top of whatever it is you may be experiencing in your Meno symptom journey.

If you are considering the option of MHT or CMT my top 3 recommendations to progress are:

  1. Start with a functional health assessment first. My GP had initially looked at my Thyroid markers, and other things, but this test looked at so much more. I wish I had known about it to begin with. It is not covered by Medicare and cost me around $1600 to get the test and the analysis. It was worth every cent for me to really understand what was happening. Your GP will order other tests as well potentially, but I just found that with the bloods, urine, and saliva sampling, lots of bases seemed to be covered.
  2. Always consult your health professional about the benefits, potential risks, and your suitability for any potential treatment. Equally ask questions of as many other women as you can. What are they on, did they have to change, what else are they doing? Arming yourself with this informal information will help you have a more meaningful discussion with your heath professional, to get you where you need to be. Also, when you are going in to discuss this option, remember to book a long appointment and have noted down your symptoms, current flow situation and any medications or supplements that your doctor is not already aware of.
  3. Don’t settle on something if you are not 100% happy. Keep asking questions and keep seeking answers. I needed a combination of things (MHT, CMT, with movement, mindset and modify practices) to really settle my symptoms. My Gynaecologist was aghast that I had consulted with a naturopath, but you know what, I feel better and that is the main thing for me. I am still going to follow up with the endocrinologist, but in the meantime, I will keep up the pre/pro-biotics, herbs, salts, and diet changes recommended by the naturopath, because they are helping massively in my experience.

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