Menopause - HRT
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Menopause and Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) emerged in the 1970s as the mainstay of treatment for menopausal symptoms, and has remained controversial ever since. It forms a substitute for some hormones that decline as menopause sets in, and commonly includes the hormones oestrogen and progesterone in combination. HRT may be used either daily (continuous use) or on certain days of the month (cyclical use).
Combined HRT (oestrogen and progesterone) is available as tablets and skin patches. Other alternatives include skin gels and implants. Local application in the form of vaginal creams, pessaries or a vaginal ring may provide relief in women with vaginal problems such as dryness. Oestrogen-only HRT has been shown to increase the risk of cancer of the lining of the womb, and is recommended only if your uterus has been surgically removed.
HRT provides the following benefits:
Oestrogen replacement forms the cornerstone of treatment for relief of troublesome menopausal symptoms such as hot flushes, vaginal dryness, sleep problems, urinary disturbances and skin changes among others.
Osteoporosis: HRT may help protect women against osteoporosis, a health condition which results in porous, weakened and brittle bones, prone to fractures. Postmenopausal women on replacement therapy have been shown to suffer fewer fractures.
Colorectal cancer: The risk of developing cancer of the large bowel and rectum also appears to decline significantly in women on HRT
Heart disease: Treatment with oestrogen modifies blood lipids as it increases HDL cholesterol levels (the "good" cholesterol), and lowers the LDL cholesterol levels (the "bad" cholesterol). This, however, has not been shown to significantly translate into a reduced risk of heart disease in postmenopausal women.
Others: HRT has been shown to prevent macular degeneration resulting in age-related vision loss and may also delay the onset of Alzheimer's disease.
Risks and possible side-effects of HRT include
Nausea, breast tenderness, bloating, fluid retention and weight gain; negative effects on mood, with resultant irritability and depression
Cancer of the uterine lining (endometrial cancer) with oestrogen-only pills
Slightly increased risk of breast cancer after 4 or more years of HRT
Increased risk of blood clots within blood vessels
Increased risk of stroke, especially in older postmenopausal women on high doses of HRT.
The risk of heart disease may also be higher in those on HRT
The advantages and benefits of short-term therapy in those with moderate to severe menopausal symptoms usually outweigh possible risks. HRT must be avoided in women with history of breast cancer, heart disease or previous history of blood clots.
Experts are of the opinion that replacement should be prescribed only to those women with most severe menopausal symptoms interfering with the quality of life and then at the lowest possible dose for an appropriate duration.
You should talk to your GP about individual risks and benefits of HRT.
Benefits Vs Risks (Short term HRT use - less than 5 yrs)
Benefits of Short Term HRT
Risks of Short Term HRT
- Improves mental skills (verbal memory and reasoning)
- Improves sense of well-being
- Decrease in sleep interruption
- Decrease in urogenital atrophy (atrophy of the vagina and urinary tract)
- Decrease in mood swings
- Decrease in hot flushes
- Possible increase in breast cancer risk
- Increase in gall bladder disease
- Increase in heart attack risk
- Slight increase in risk of stroke
- Increase in risk of deep vein clots