Debunking common myths

Myth 1: It can’t be menopause until all periods have stopped.

FALSE: The average woman is perimenopausal for four years, but in some cases the perimenopause can last for 10-12 years. There is no need to wait for periods to cease before starting hormone replacement therapy (HRT). In fact, many of the benefits of HRT are best secured by starting HRT earlier rather than later. The so-called ‘golden window’ for starting treatment closes five to ten years after the last period, or by the age of 60.^1,2 You should consider that women may not be having periods due to hormonal contraception or endometrial ablation. It is also important to discuss lifestyle advice as part of a management plan.

Myth 2: You can’t have HRT if you have had cancer.

FALSE: While it is important to discuss the risks, benefits and alternatives to HRT with patients who have had cancer, there is no blanket rule that says that you can’t have HRT if you have had cancer. 

Myth 3: HRT increases the risk of breast cancer.

TRUE (it depends on the HRT prescribed): HRT and its impact on breast cancer risk is a subject that continues to divide professionals. When discussing breast cancer risk with patients, it is helpful to consider an individual’s overall risk as being the total of their different ‘layers’ of risk, including genetic, lifestyle and HRT choice. See the BMS’ Understanding the risks of breast cancer infographic, to demonstrate a useful way to summarise the risks. The BMS Fast Facts tool is also useful to help you communicate breast cancer risk.

Myth 4: You can’t have oestrogen if you have a migraine with aura.

FALSE: This myth seems to have emerged through linkage with the rules around the combined pill and migraine with aura. The oestrogen in HRT is different; it is natural, not synthetic, and is not thought to be as impactful on blood clotting. HRT is not contraindicated in women who experience migraines, but generally they may be offered transdermal products with confidence.¹ 

Myth 5: Stopping HRT will restart menopause symptoms.

TRUE & FALSE: This will vary between individuals, and with the age and stage at which HRT is stopped. HRT does not delay menopause. If a woman is still having symptoms after stopping HRT, it means that they would still be having symptoms if they have never taken HRT. Some people will also continue to have vasomotor and other symptoms of the menopause until well into later life. Around 42 per cent of 60-65-year-olds still experience symptoms.³

Myth 6: HRT is not suitable for smokers or people with blood clots.

FALSE: Oral HRT can increase the risk of venous thromboembolism.³ However, the current evidence suggests that women at higher risk of blood clots (including those with previous clots or with higher BMI) can be safely offered transdermal HRT.⁴

Myth 6: You don’t need to worry about pregnancy when perimenopausal.

FALSE: Perimenopausal women are still ovulating and therefore require contraception to avoid pregnancy. HRT is not a form of contraception. The doses in most forms will not be high enough to suppress the pituitary axis and prevent ovulation.