HRT

All women make the two female hormones, oestrogen and progestogen, in various amounts throughout their reproductive life. Towards the later thirties to forties the amounts of these hormones starts decreasing, until the change, perhaps around forty-five to fiftyish. There is no fixed time when this will happen, although the best guess guide would be the age that it happened to your mother or older sisters. After the menopause the hormones fall to very low levels, and of course, this results in you having no periods. On the down side, the hormones are there for a purpose, and when they are no longer there you may notice some or all of the following symptoms:

C no periods

D vaginal dryness and perhaps some soreness with intercourse

D hot flushes, facial flushing

D thinning of the bones

D some slight hair growth

D a general feeling of tiredness, perhaps partially due to hot flushes waking you in the middle of the night

D subtle psychological changes, including changes in sex drive

Many women notice nothing much more than a few inconvenient flushes for a few months. Other, less fortunate women, may have devastating symptoms of the menopause, and they may well be helped significantly by hormone replacement therapy. Most women suffer some inconvenience- this may be helped by hormone replacement.

What is Hormone Replacement Therapy?

Hormone replacement therapy is using the oestrogen, either by a pill, a patch, an implant under the skin or a vaginal cream, to restore levels in the tissues similar to what the body already has. In women who have not had a hysterectomy, it is important that a progestogen pill be given, for several days in the month. This is to prevent a thickening of the lining of the womb occurring, which could cause cancer of the womb.

What are the risks of Hormone Replacement Therapy?

Hormone replacement therapy takes the body to the state it was before the change, when breast cancer is more aggressive.

Remember when you are reading this- a doubling of a very small risk is still a very small risk

*******HRT provides the hormones to take you back to the way you were before the menopause. Because of this, there is a very small increase in the chance of early breast cancer, compared with post-menopausal women not taking HRT. Amongst women not on HRT, there are 45 breast cancers diagnosed in the 20 years following the menopause per 1,000 women. After 5 years on HRT, there will be 2 extra breast cancers amongst 1,000 HRT users: after 10 years on HRT, 6 extra per 1,000 HRT users.

There is a small increase in the remote risk of developing a blood clot in the leg on HRT

D ********In women not on HRT, this is about 1 in 10,000 per year, with a 1 in a million chance of dying from it. For women on HRT, the very small risk of a clot trebles to about 3 in 10,000, with a 3 in a million chance of dying from it.

D ****heart attacks & stokes may be very slightly more on hormone replacement therapy on some types of combined HRT that women who have a uterus have to use- but possibly not increased on oestrogen only HRT

And the benefits?

C Alzheimer’s Disease is less in women who have had HRT. So is cancer of the colon

C osteoporosis (thinning of the bones), and fractures of the hip, wrist and back-bone are less in women who have had HRT- a halving of the risk after five to ten years of HRT

There is a balance of risks- if you have really bad symptoms of Hot Flushes ruining your life, you may well consider it worth using HRT for several months or more

Who should not have Hormone Replacement Therapy?

D Anybody with previous problems with clotting of blood e.g. a past history of blood clots in the leg, will need special consideration. Varicose veins are no problem.

D People with a past history of gynaecological or breast cancer will need special consideration.

D People with migraine occurring for the first time or getting more frequent on hormone replacement therapy.

D Anyone else whom the doctor considers it would be unwise to use hormone replacement therapy.

Who would particularly benefit from Hormone Replacement Therapy?

Virtually any woman may try it, although not all will get the same benefit. In particular, women with very severe hot flushes, perhaps leading to tiredness, or women with a strong family history of osteoporosis e.g. a mother who fractured her hip before 70. The most likely people to suffer osteoporosis are white women who are relatively lightly built, and who smoke, and with a strong family history. Hormone replacement therapy may well be beneficial for them.

What Hormone Replacement Therapy won’t do

It is not a youth pill. It won’t put the clock back ten years as far as overall vitality, zest, wrinkles etc. are concerned, although a few lucky women do seem to have very marked changes. Don’t expect it, despite what the women’s magazines say.

What are the adverse effects of Hormone Replacement Therapy?

D If you haven’t had a hysterectomy you may well find that your periods return.

D Some women find breast tenderness.

D Some women get some weight gain.

I’ve read about a HRT tablet that means you don’t have to have periods back

There are two forms. Both can only be used in women who haven’t had a period for at least 18 months, and are over 52 years old.

You do not have to have a period every month on HRT- one HRT, Tridestra, reduces them to four a year, if you wish.

What form of HRT should I take?

Some women use a tablet each day (it’s not critical, if you miss an odd pill), others patches changed twice weekly, still others have a vaginal cream. Some brave souls choose to have an operation every few months to have an implant inserted under their skin.

At least with a pill, you know exactly that the HRT is all in your body, unlike the patches, which leach the oestrogen erratically through your skin, depending on the blood flow, temperature, exercise, etc.

How long should Hormone Replacement Therapy go on for?

Doctors used to be happy with long- term HRT, but now we know more about the very slightly increased risks of breast cancer, we think it’s probably best not to take it for years and years and years.

What should I do now?

Think about it for a couple of weeks. If you wish to try hormone replacement therapy, and you haven’t had a hysterectomy, first of all make sure you have had a recent smear. If you haven’t had one in the past three years ask Sister to do one. Then make a double appointment to discuss it with your doctor and for him to check you over with a view to starting HRT.

Tell him if you think you have any of the above problems. He will probably start you on one of the safe, well-tried and tested forms of HRT, such as conjugated oestrogen (Prempak-C or Premarin). Unfortunately, if you pay prescription charges, you will have to pay two charges for the combined preparations.

BRN 1997

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