The big HRT re­think

For­get ev­ery­thing you thought you knew about hor­mone re­place­ment ther­apy. Views on their risks and ben­e­fits are chang­ing

Woman's Weekly (UK) - - HELLO! -

Q So what’s the lat­est think­ing? That, far from be­ing a risk to women’s health, hor­mone re­place­ment ther­apy (HRT) is not only the most ef­fec­tive way to deal with many menopause symp­toms, it may ac­tu­ally im­prove women’s health. Some ex­perts say that oe­stro­gen re­duces the risk of heart dis­ease (sta­tis­ti­cally a big­ger threat to women’s health than breast can­cer), de­men­tia, os­teo­poro­sis and cer­tain can­cers – and that it ac­tu­ally in­creases a woman’s over­all life ex­pectancy.

Q What about the risk of get­ting breast can­cer? The risk was high­lighted in a 2002 study by the Women’s Health Ini­tia­tive (WHI), which linked HRT to an in­creased risk of breast can­cer, stroke and heart at­tack. But crit­ics point out that the study was flawed and in­ac­cu­rate – the breast-can­cer risk was, in fact, sta­tis­ti­cally in­signif­i­cant (you have a higher risk of breast can­cer if you’re over­weight or you don’t ex­er­cise), and the HRT type stud­ied was dif­fer­ent from the HRT pre­scribed now.

What’s more, the av­er­age age of women used in that re­search was 63, when most would have started on HRT more than 10 years ear­lier,) when menopause symp­toms start and are usu­ally most se­vere. The group also had a higher than av­er­age col­lec­tion of pre-ex­ist­ing health prob­lems – half were ex- or cur­rent smok­ers, around 70% were over­weight or obese, and over a third were be­ing treated for high blood pres­sure, all of which would have raised their risk of a host of health con­di­tions, in­clud­ing heart dis­ease, stroke and cer­tain can­cers.

✿ Read the new book Oe­stro­gen Mat­ters by med­i­cal on­col­o­gist Dr Avrum Blu­min and so­cial psy­chol­o­gist Carol Tavris, PhD (£13.99, PB, Lit­tle, Brown).

Q What symp­toms can HRT help al­le­vi­ate? It abol­ishes the main ones – hot flushes and sweats, and vagi­nal dry­ness caused by low oe­stro­gen lev­els (de­tectable us­ing blood tests).

Woman’s Weekly’s Dr Mel Wynne-Jones says, ‘It of­ten helps linked symp­toms such as sleep dis­tur­bance, tired­ness, aches and pains, ir­ri­tabil­ity, low sex drive, uri­nary ir­ri­ta­tion/in­con­ti­nence, anx­i­ety and/or de­pres­sion – although some­times these are ac­tu­ally due to thy­roid or other med­i­cal con­di­tions in­stead.’

Longer term, low oe­stro­gen lev­els re­duce tis­sue-sup­port­ing col­la­gen and can lead to wrin­kles, pelvic-floor weak­ness and thin­ning bones – although HRT isn’t pre­scribed specif­i­cally to pre­vent os­teo­poro­sis. Q What are the dif­fer­ent types of HRT avail­able? There are many – your GP can help you de­cide which, if any, will suit you best.

If you’ve had a hys­terec­tomy, you’ll only need oe­stro­gen. If not, you’ll also need a pro­ges­terone-like hor­mone to pre­vent over­stim­u­la­tion or can­cer of the womb lin­ing. This can be pre­scribed as tablets or as the Mirena in­tra-uter­ine sys­tem (IUS), which also pro­vides con­tra­cep­tion.

Pe­ri­ods con­tinue with cycli­cal com­bined HRT, but if it’s more than a year since they stopped, you can take con­tin­u­ous com­bined HRT with which you’ll have no bleed­ing.

Oe­stro­gen-only HRT can be given as tablets, skin patches, gels, im­plants, vagi­nal rings, or as a vagi­nal cream or pes­saries. Ti­bolone, which stim­u­lates oe­stro­gen re­cep­tors but con­tains no oe­stro­gen, may also be ef­fec­tive.

Some women find pro­ges­tero­neonly HRT or ‘bio-iden­ti­cal’ hor­mones help, although more re­search is needed to clar­ify the risk/ben­e­fit bal­ance Q So should I go on it? That’s a de­ci­sion only you can make, in con­sul­ta­tion with your GP. No drug is com­pletely free from po­ten­tial side-ef­fects. Some women on HRT suf­fer from breast ten­der­ness or ir­reg­u­lar bleed­ing, but al­ter­ing the pre­scribed dosage, in con­sul­ta­tion with your GP, can of­ten al­le­vi­ate these. Oe­stro­gen as a tablet (in­stead of a patch or gel) can also marginally in­crease your risk of a blood clot. But the change in think­ing around HRT should make you more will­ing to see your GP to talk about menopause symp­toms which are af­fect­ing your life.

In re­cent years, women have thought the menopause is some­thing they have to sim­ply put up with, says TV doc­tor Pixie McKenna: ‘When it comes to HRT, we have done women a great dis­ser­vice, and we have de-skilled our­selves as GPs.’ But things are chang­ing.

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