MHT not the answer for all symptoms

4 minute read

Women need to be given ‘realistic expectations’ around menopause and its treatment say researchers.

Clinical evidence does not support the use of menopausal hormone therapy solely for clinical depression, cognitive symptoms or brain fog, Australian researchers say.

However there is international consensus on prescribing MHT to treat hot flushes and night sweats, mood disturbance and vaginal symptoms, and to prevent bone loss.

The systematic review of international menopause guidelines, led by Melbourne endocrinologist and sex hormone researcher Professor Susan Davis, was published in BMJ Sexual & Reproductive Health.

Professor Davis told TMR it was important distinguish between classic symptoms of menopause and broader symptoms such as fatigue, brain fog, headaches and weight gain that could have many other causes.

“We have to give women realistic expectations that while menopause can cause horrible symptoms, not every symptom a woman experiences during this life phase can be attributed to menopause, and if they have other symptoms they need to get them investigated in case something else is going on,” she said.

As an example, the director of the Women’s Health Research Program at Monash University said a woman with cognitive symptoms but without hot flushes would need further investigation.

“Is a drop in estrogen without any other effects causing the symptoms of brain fog? Or are they just part of a consequence of all the other things like the hot flushes, night sweats, disturbed sleep? And I think that’s the nuance,” said Professor Davis.

“If somebody has clinical depression … you really have to look at what’s causing the depression in the person before just throwing hormones at them.”

Women could sometimes be disappointed that MHT did not fix every symptom, Professor Davis said.

“We don’t want women attributing everything they’re experiencing to menopause and saying ‘I’m peri-menopausal, all these things are happening to me’,” she said.

“Often all those things are about stress in life, and what happens is women are really disappointed that HRT is not amazing.”

The review informed the latest update of the Australian Practitioner’s Toolkit for Managing Menopause, Professor Davis said.

The researchers also reviewed the evidence around complementary and alternative medicines (CAMs) and said only cognitive behavioural therapy and hypnosis were recommended for menopausal symptoms.

There was no evidence to support the benefit of complementary therapies – such as acupuncture, ginseng or black cohosh – for menopausal symptoms because they were either ineffective, unproven or had questions around their safety, they said.

Compounded hormones were also potentially unsafe, they added.

“All the money women are spending on these things is not a good use of their income,” Professor Davis said.

The researchers said early clinical practice guidelines noted that phyto-estrogens had potential therapeutic benefits but findings have been inconsistent.

The increasing influence of social media was a concern raised by the authors, who highlighted one national study that found 13% of Australian women and 19% of perimenopausal women used complementary therapies to manage their vasomotor symptoms.

“The ability for clinicians to be able to offer evidence-based, effective, non-hormonal options for women is crucial, especially considering the ready availability and use of unproven and potentially unsafe CAMs,” the authors wrote.

“Communication of the ineffectiveness of most of these therapies will enable clinicians to better support women who are considering their use to make informed choices.”

Professor Davis said women were “desperate for answers”, but researchers needed more women to participate in clinical trials.

“We are desperately trying to recruit women to clinical trials,” she said.

“If they want the answers, they’ve got to help us and participate in studies. It’s really important that women are prepared to go into clinical trials to help us find the answers.”

BMJ Sexual & Reproductive Health 2024, online 9 February

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