Why I’ve changed my mind about Menopausal Hormone Therapy

The advocacy of more than 2000 pissed-off menopause warriors pushed me to research and rethink the role of MHT in keeping women healthy in their later years.

I’ve concluded that the benefits of taking the drugs significantly outweigh the relatively small risks.

I was firmly of the age when I was supposed to be experiencing perimenopause when I first heard the term. Suddenly the phenomenon was everywhere. How could it have passed me by? It goes on for ten years! It often starts when you’re 40! According to a sudden onslaught of discussion, I shouldn’t be able to think straight or sleep; perimenopause is supposedly at the root of every anxiety. Yet at 47, I’m still experiencing zero symptoms. Which is part of the reason I’ve reacted to the deafening conversations around menopause with
some scepticism.

The union movement’s push for workplace menopause leave has me bristling, insulted by its sex-based exceptionalism. The so-called menowars that rage over the prescription of Hormone Replacement Therapy (HRT – now known as Menopausal Hormone Therapy, or MHT) has left me baffled.

When it comes to reproductive health, I’ve long been of a decidedly non-interventionist bent. The pill has never agreed with me. I don’t like to take medication unless I absolutely need to. I pushed my babies out with no drugs. I know I’m lucky that labour and birth for me were uncomplicated. I completely respect women who make different choices but for me, non-interference has always just felt instinctive. So when I found myself at a conference recently with more than 2000 menopause warriors who packed out Sydney Opera House, it was like waking up one morning to discover World War III had erupted. These women were pissed off.

Beyond talk of perimenopause (a relatively newly coined word for the pre-menopause years), a culture war was raging. Medical misogyny, I learned, was routinely misdiagnosing women, shunting them onto antidepressants when they really needed MHT, condemning them to a markedly higher risk of chronic disease through the patronising gatekeeping of hormone drugs. Men with erectile dysfunction had easy access to Viagra while women couldn’t get MHT for love nor money! Women were in tears describing their mothers’ menopause, vowing to not let their lives be similarly blighted by preventable and treatable symptoms. I couldn’t relate to this, either. My own mother experienced some mild symptoms, mostly night sweats, during menopause, but she mostly sailed through. I do recall, mind you, my friend Sonia turning up to school in around 1994 and recounting how her menopausal mother had approached the family dinner table the previous night wielding a chainsaw, threatening to cut the table in half.

I don’t own a chainsaw but the menowars did prompt me to look into the evidence – and it has fundamentally challenged my mindset about MHT, at least.

In the mid-1990s, up to 40 per cent of menopausal women in western countries were taking HRT. Doctors saw it not only as a treatment but also a potent prophylactic in reducing the risks of a suite of conditions. Yet when the notorious Women’s Health Initiative clinical trial results were leaked and widely misreported in 2002, warning of a heightened risk of breast cancer from the drugs, HRT prescriptions plummeted.

Having looked at the research carefully, I’ve concluded that the benefits of taking the drugs significantly outweigh the relatively small risks. Women die in greater numbers than men of heart disease after the age of 50, and the hormone drops that come with menopause are one reason why – they spark inflammatory processes in the body, raising cholesterol and sometimes blood pressure, increasing the risk of heart disease five-fold. When MHT is taken within 10 years of menopause starting, it reduces the risk of coronary artery disease by 48 per cent, according to a Cochrane review. The benefits in preventing bone density loss and osteoporosis are similarly great.

There’s a small increase in breast cancer risk for women taking combined MHT, i.e. oestrogen and progesterone. But the combined therapy is associated with significant risk reductions in endometrial cancer, ovarian cancer, and small decreases in the risk of dementia. There’s a critical window of time – the first 10 years after the onset of menopause – to reap the preventative health benefits of MHT.

With that in mind, I say thank you to the menopause warriors for bringing public attention to the benefits of these hormone drugs in circumstances where the medical fraternity remains risk-averse and often ignorant.

Despite my natural bent, and lucky escape so far from the perimenopause years, there’s now no doubt in my mind that I’ll be lining up for MHT as soon as menopause arrives, whether I’m inclined to saw a dinner table in half with a chainsaw or not.