Is HRT truly the wonder solution to menopause?

Waking up in the middle of the night, drenched in sweat despite the air conditioner at 18 degrees, and constantly irritated over even the smallest things—these were just a few of the struggles my mother faced as she navigated menopause. Some days, the tension would build up so much that we’d have to retreat to separate rooms, simply because no one wanted to freeze or endure a hot flash of anger. “If my doctor had mentioned hormone replacement therapy (HRT) eight years ago, I would’ve taken it in a heartbeat,” she tells me. In a country where menstruation has long been considered a taboo, it’s no surprise that menopause and its symptoms are similarly stigmatised.

Menopause is a challenging transition for women, bringing with it significant physical, mental, emotional, and psychological changes. Dr Devika Chopra, consultant obstetrician and gynaecologist, and founder of The Hope Clinic, explains that most menopausal symptoms are distressing and often prevent women from leading a normal life. During this time, the body’s production of hormones—particularly oestrogen and progesterone—declines, with oestrogen being the most affected. Oestrogen plays a crucial role in regulating the menstrual cycle, maintaining bone health, and controlling body temperature. A decrease in oestrogen levels leads to a range of menopausal symptoms that can severely impact daily functioning. Severe hot flashes, which cause excessive sweating at inopportune moments, fluctuating mood swings that strain relationships, and joint pain that can limit mobility, are just a few examples. “These symptoms only worsen over time, which is why doctors should prescribe hormone replacement therapy (HRT) whenever necessary,” she emphasises.

HRT or menopausal hormone therapy (MHT), as the medical community refers to it now, stabilises the levels of oestrogen, preventing any extreme symptoms of menopause. This stabilisation comes as a necessity because of what depleting oestrogen levels do to a woman’s body. Dr Chopra explains that oestrogen shields women from osteoporosis and even cardiac disease because it’s cardioprotective. “Reducing oestrogen levels often result in not just cardiac issues, but also cholesterol and thyroid issues, making it abundantly clear that this hormone plays a crucial role in regulating other hormones.” HRT replaces the lost hormones when a woman’s menstrual cycle stops, between the ages of 45 and 55. These hormones aren’t entirely replenished, only a certain amount is replaced for a fixed period, depending on the symptoms being dealt with.

Initially, doctors were hesitant to prescribe these hormones to women because of the infamous Women’s
Health Initiative study. It found that those taking Prempro, a combination of oestrogen and progesterone, had a higher risk of developing breast cancer or experiencing a stroke. Dr Chopra reminds us that this was an imperfect analysis, which is not as relevant today. “A sonography of the pelvis, a mammogram along with a thorough physical check-up is always conducted to rule out a history of cancer or heart disease,” she says. With synthetic and natural options dispensed through topical creams, tablets, patches, and by infusion in some cases, HRT has evolved to offer relief to anyone who needs it. 

Rachel Kurien, a British reflexologist who regularly organises symposiums and support groups on menopause, resorted to bio-identical HRT to solve her problems. Wanting to manage her health naturally instead of depending on allopathy medicines, she tried every alternative therapy—acupuncture, Ayurveda, and homoeopathy, but nothing worked. Bio-identical HRT creates hormones that are chemically identical to the ones produced in our body, making them easily absorbable. Kurien used these hormones for just a week and her symptoms improved drastically. “I was beginning to get osteoporosis, which started getting better along with my cardiovascular health improving too,” she elaborates. 

Given that women spend one-third of their lives experiencing it, the response to menopause and its effects has rather been riddled with indifference, by everyone alike. Dr Chopra believes that this is rapidly changing with doctors offering HRT as an option and women making informed decisions to demand it. Some women, like Nupur D’Souza, an educator, decided to approach HRT more systematically when she was younger and active with great cardiovascular health. “Hormone fluctuations affect mental health drastically. This gave me the vigour to research HRT and speak to my ob-gyn for support,” she reveals. The idea of suddenly missing a necessary hormone in the body was terrifying to her, especially after witnessing older friends go through it. “Generally, women’s bodies age so fast, even more so when there’s a sudden oestrogen drop,” she says. Worried about certain consequences of menopause such as vaginal dryness, which leads to discomfort and painful sex, along with deteriorating mental health convinced D’Souza that HRT is the correct answer. 

Several women have reported positive changes in their lives after HRT, proving that it is a powerful tool in the arsenal to battle menopause. Dr Chopra reveals that an increasing number of women are opting for HRT, instead of just enduring the terrible symptoms of menopause. This cultural shift in attitude towards menopausal health has allowed women to recognise their symptoms as genuine medical concerns, instead of suffering in silence.

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