Menopause Mastery: Part 2 - Give Women Their Hormones Back
In continuation of Part 1 of this blog post series, in recognition and celebration of International Women’s Day 2023 (8th March), we interviewed Lexie Minter, who heads up the menopause treatment clinic at the Thrive4Life Wellbeing Centre.
In a previous life, Lexie Minter was an A&E nurse and a midwife. Now a highly experienced menopause practitioner and Nurse Prescriber, she strives to educate women about the perimenopause and the menopause, explaining how hormone replacement therapy (HRT) can improve long-term health and wellbeing, easing the transition into the post-menopausal period.
In the second part of Lexie’s interview, she will be shining a light on HRT: the myths, the evidence, and real-life testimonies which reveal how it could help you or your loved ones manage symptoms of the perimenopause, menopause, and post-menopausal period.
Lexie Minter runs the Lloyds Wellbeing Centre’s menopause treatment clinic, and is a highly experienced menopause practitioner and Nurse Prescriber with a special interest in hormone health.
“I’m an independent Nurse Prescriber with a special interest in menopause and hormone health. I’ve been a registered nurse for over 20 years and have worked in a variety of disciplines, including Accident & Emergency, Occupational Health, Midwifery, Primary Care, Corporate Health and Wellbeing.”
“We don’t need to spend this period of our lives suffering. Nobody should be limited by something so immensely fixable – it’s time to give women their hormones back.”
Lexie Minter – Lloyd’s Wellbeing Centre menopause practitioner (BSc Nursing, BSc Midwifery, Independent Nurse Prescriber)
I’ve heard of links between HRT and cancer – wouldn’t it be better just to go through the menopause naturally and let the symptoms happen?
About 100 years ago, women would have spent most of their lives pregnant, and died around the age of the menopause. However, now, we’re probably going to live as long in our post-reproductive years as our reproductive years, often another 30 years or so after our last periods. Interestingly, when looking at surgically induced menopause, statistics show that women who have undergone a bilateral oophorectomy (removal of the ovaries) die of all causes much sooner because they’re lacking that oestrogen which is essential for all aspects of our health.
Due to a study published around 20 years ago, there are a lot of myths surrounding HRT and breast cancer. However, this study was based on a now outdated form of HRT made from horses’ urine that was combined with old, synthetic progesterones. We’ve since proved that HRT does not have significant links to a higher breast cancer risk, but, like the old MMR study and its ties to autism, we can’t quite break the repercussions of this conversation.
It's important to explain that everyone has a background risk of breast cancer. If we add in the combined hormonal contraceptive pill or HRT, this risk does slightly increase. However, smoking, obesity, or drinking alcohol also increases your risk, so it’s essential to look at the whole picture. Interestingly, fewer cancer cases are associated with women who have oestrogen-only HRT after having had a hysterectomy – this is because the breast cancer risk actually comes from the choice of progesterone, not the oestrogen. As mentioned previously, this risk is tied to older types of synthetic progesterones. Nowadays, we use a progesterone called Utrogestan, which has a much better safety profile and excellent evidence of being breast-safe. It’s also naturally made from yams, not horses’ urine, which you’ll be pleased to know! Furthermore, HRT used to be taken orally, which meant that the hormones were metabolised by the liver, creating a risk of clotting. Now, they’re absorbed transdermally, through the skin, in much the same way your body would expect to get oestrogen. Furthermore, we use estradiol (a mixture of oestrogen, progesterone, and testosterone that is normally produced in ovarian follicles) rather than synthetic oestrogen, meaning that women who have histories of blood clots, migraines, and high blood pressure can also take HRT without worry.
Currently, it is possible for almost every woman to be given HRT safely. There are only a couple of exceptions: if you have (or have had) a current oestrogen dependent type of breast cancer or if you have active liver disease. In these cases, the treatments available to you might vary. However, every woman should be able to have a conversation about her risk factors and whether HRT would be a safe option for her.
Can you talk more about Hormone Replacement Therapy (HRT)?
Testosterone is another highly significant hormone. Women tend to begin to lose testosterone in their thirties - it’s not as significant as the loss of oestrogen, but it can also be replaced. Replacing it can benefit many women because testosterone works with our doping receptors, and a lack of it can interfere with our sense of joy. Many women I speak to tell me that they feel like they’ve just lost their ‘vavavoom’! So, we prioritise getting the oestrogen dosing right first, then we can do a trial testosterone dose. This won’t make you get hairy or grow a beard - the dosing is so low it can take 4-6 months to really start to feel the benefits. It’s important also to mention that this is a very new practice – we’re extremely cautious about prescribing testosterone at the moment as evidence is still being collected, and we always closely monitor its effects with regular blood tests. However, over the next few years, I think we’ll be prescribing it much more regularly, in much higher doses too.
Can you give an example of how patients can benefit from HRT?
Recently, I had a 57-year-old patient who was presenting with a range of cardiac symptoms. I listened to her symptoms, and I actually thought “she’s got a cardiac condition; HRT isn’t going to solve this”. I thought she should go to hospital and have a full cardiology workup done, but she hated hospitals and didn’t want to go, so I trialled her on HRT and her symptoms totally vanished. She had been experiencing moments where she’d wake up throughout the night with an impending sense of doom, extreme night sweats, and severe hot flushes, and HRT completely resolved these symptoms.
Another patient I had was a 60-year-old lady who said she’d been hobbling around for years with chronic joint pain. Once I got her started on HRT, she said she was going to take her painkillers back to her GP. She couldn’t believe she’d had to deal with these aches and pains for so long, and she said it was like WD40 for her joints – physically, she felt 10 years younger.
If you think that you may be struggling with signs or symptoms of perimenopause or menopause, what are the first steps one should take to get professional help?
Dr Louise Newson, a menopause expert, has released an app called Balance – you can write down any symptoms you’re experiencing, and it gives you the tools to speak to a GP about what you’re going through.
Any women who have had a history of oestrogen positive breast cancer should get their GP to refer them to a menopause specialist, because whilst they have survived the cancer, a lot of them will be on medication to stop any oestrogen in the body. With the right support, their symptoms can be managed.
What approach do you take towards treating your patients?
I also believe that we need to make the menopause a more positive source of conversation. There is something we can do about the symptoms it causes – we don’t need to spend this period of our lives suffering. We also need to understand what’s normal regarding our reproductive health and start talking about it!
Nobody should be limited by something so immensely fixable – it’s time to give women their hormones back.
Did you miss Part 1 of our Q&A with Lexie Minter (published 8th March 2023)? Go and read that blog post if you’d like to read more on the subject of menopause.
