Hormone replacement therapy - often delivered through patches - has sparked debate among health researchers. Photo / Getty
A GP and specialist in women’s health is pushing back against the suggestion that hormone replacement therapy (HRT) is being overprescribed.
HRT is used by thousands of women across New Zealand who are dealing with peri-menopausal symptoms. It is commonly delivered through patches that release oestrogen in a controlled way to assist in mitigating symptoms.
The treatment has risen in popularity and recognition in recent years, to the point that the country is running low on the patches.
It has also led to some researchers now declaring that HRT is being overprescribed. A paper by Australian researchers published in medical journal The Lancet earlier this year said menopause had “been turned into a disease, a hormone deficiency disease, which requires diagnosis and treatment”.
The Australasian Menopause Society released a statement in July, raising concerns about some of the ways in which HRT had been promoted.
Samantha Newman is a GP focused on women’s health, who works with the University of Auckland and the University of Monash in Melbourne. Speaking to Francesca Rudkin and Louise Ayrey on The Little Things, the Herald’s lifestyle and wellbeing podcast, she says women go through multiple hormone changes as they age and experience puberty and reproductive cycles.
She sees HRT as not just replacing hormones but supporting them and dismisses the idea that it is a fad.
“It’s really hard for me and other doctors, when we see these hormone changes occurring in the late 30s, and often it starts as anxiety and irritability and premenstrual symptoms.
“I wanted to say that because, if anybody listens to this and is like, ‘Oh, I completely agree, this is me’, and then they go to their doctor who’s like, ‘but one of our advisory bodies is saying this isn’t perimenopause’, and I don’t want my patients to feel – I don’t want any of your listeners to feel – dismissed or invalidated.
“For me, does it matter if by definition, this old definition of perimenopause which needs to be updated, or what they say that fundamentally, the best, most effective treatment is hormone treatment. And I believe, and there’s some incredible doctors in Australia and worldwide, that the psychological symptoms of menopause often occur five years before their physical symptoms, which then also, I’m like, why can’t I try hormones if that suits the patient and it’s appropriate – it’s a patient choice and there’s other factors at play – when it’s the most effective.”
Newman often asks patients with new symptoms about their periods and sees that as a key clue for working out what their issues are.
“As a doctor, I don’t want to miss anything. So if you’ve got new onsets, severe mental health problems, I don’t want to miss a clinical depression and a psychosis, but actually it’s rare that I can’t consider it alongside is this hormones and the same as palpitations and cardiology, but actually generally I can consider it alongside.”
She says that, from puberty and at every reproductive transition, rates of depression and mental health diagnoses increase.
“I just wonder, what really is female mental health when you factor in hormones? And do we need to look at it on the table and be like, can we do this better? Rather than saying now we’re overdiagnosing it, actually, were we missing it before? And I never thought I’d feel really confident to stand up and say that, but I’m just blown away by my patients who have trusted me.”
Asked for her key advice to women who are considering HRT as an option, Newman says they should be open-minded.
“Be open-minded about what your symptoms could be caused by, for trying different options, and also reassessing when it doesn’t work to help understand what it is. And I often use hormones as a diagnostic trial – is it working or not, and is that going to help us kind of figure out what’s going on?”
Listen to the full episode of The Little Things for more about HRT, how hormones change in women as they get older, what other options are out there, and what you can do if HRT doesn’t work for you.
The Little Things is available on iHeartRadio, Apple Podcasts, Spotify or wherever you get your podcasts. The series is hosted by broadcaster Francesca Rudkin and health researcher Louise Ayrey. New episodes are available every Saturday.
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