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It's been 200 years since a French physician coined the term "menopause." And for most of that time, it was spoken of in euphemisms ("she's going through 'the change'"). However, the conversation is finally shifting -- now, you can't open Instagram without hearing about it. Menopause itself is simply the day that marks 12 months since your last period, which usually happens between the ages of 45 and 55. But perimenopause starts up to 10 years earlier, during which fluctuating estrogen levels can cause a smorgasbord of unpleasant symptoms, from hot flushes and brain fog to aching joints and vaginal dryness. There are new treatments, too -- like hormone replacement therapy.
Despite a newfound willingness to talk about all these symptoms, there's still confusion over the most common treatment: hormone replacement therapy (HRT). Currently, standard HRT is a combination of estrogen and progesterone. It may be administered as a pill, gel, patch, or spray, and you can start taking it when you're perimenopausal before your periods actually stop.
"HRT is recommended for intrusive menopause symptoms," says Professor Annice Mukherjee, consultant endocrinologist and author of The Complete Guide to Menopause. "Used in midlife, it also helps keep your bones strong. But with longer-term use, especially in women with complex health issues and those older than 60, the risks, for some, start to outweigh the benefits."
It's complicated. Some studies have found there's a higher chance of uterine or breast cancer, which sounds bad on paper, but the risk is low in healthy women under 60. Most doctors are now pro-HRT for anyone struggling with symptoms, although some remain more cautious than others.
Frustratingly, as with many aspects of women's health, there's scant medical research, and many doctors have not had menopause training, so your GP might not be as informed as you'd hope unless they have personally sought additional education.
Dr. Juliet Balfour is a GP with an Advanced Certificate in Menopause Care from the Royal College of Obstetricians and Gynaecologists (like Professor Mukherjee, she is also a member of the British Menopause Society's Medical Advisory Council). "There's a need for more good-quality research on women's health issues," she says. "Randomized double-blind placebo-controlled trials take years and are expensive. We have good evidence for many of the benefits of HRT, but some clinicians discuss benefits that are not yet backed up by evidence."