The lost art of MHT prescribing

Dr Aajuli Shukla

writer

Dr Aajuli Shukla

General Practitioner; Deputy Medical Editor, Medical Journal of Australia; Member of the Editorial Advisory Board for the Diabetes Management Journal

Dr Aajuli Shukla

 
Past controversies have left their mark. 

Ever since the Women’s Health Initiative back in 2002, Menopausal Hormone Treatment (MHT) has been a contentious issue.

The fallout meant there was likely to be a whole generation of doctors who had little experience in prescribing MHT and discussing the risks associated with it appropriately, says Dr Terri Foran, a sexual health physician with a special interest in menopause issues.

But the pendulum has swung back. A re-examination of the data showed that, in fact, the use of MHT in younger women and women with early menopause can reduce coronary disease and all cause mortality.

In the last ten years, Dr Foran has noted a return to a more reasonable approach with regards to the prescribing of MHT.

For a woman who is under 60 and very symptomatic during the peri-menopausal period, MHT can be incredibly beneficial.

What’s important, Dr Foran says, is how we frame our discussion around the risks. Rather than focusing on relative risks which can always be tricky to explain properly, a better approach might be to contextualise the risk. For example, explaining the risk of taking MHT for five years versus having two alcohol drinks everyday or versus having a baby after the age of 31.

It is also important to discuss the different risk profiles of the various delivery options for MHT. Transdermal options tend to have a much lower venous thromboembolism risk than other modes of delivery.

Over the last 10-15 years, women have been starting to feel more empowered to look for solutions to their quality of functioning as they grow older. Experiencing menopausal symptoms is incredibly common.

One of the other issues impacting the use of MHT centres around their availability and cost. Over the last few years, and especially in the setting of the pandemic, certain forms, and brands of MHT have been difficult to source.

Several of these are not listed on the Pharmaceutical Benefits Scheme, which makes access for disadvantaged women difficult.

It is important to be mindful of the different brands that might be currently available locally and if they are listed on the PBS. Learning about the management of menopause through MHT is an important skill GPs need to have to help their patients navigate the myriad of choices available to them.

Dr Terri Foran will be providing a presentation on MHT at the upcoming Healthed webcast on 30 August – register here.

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Dr Aajuli Shukla

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Dr Aajuli Shukla

General Practitioner; Deputy Medical Editor, Medical Journal of Australia; Member of the Editorial Advisory Board for the Diabetes Management Journal

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