HRT
HRT – THE REALITY BEHIND THE HYPE
A recent magazine survey of 2,000 menopausal women found that 75% would not recommend HRT to their daughters. This is in spite of over 80% of respondents believing that HRT did actually work.
So why this reluctance?
There has been a lot of speculation and hype surrounding the risks and dangers of HRT in the last few years, leaving many women confused as to whether it is safe to take or not.
De Faye’s chemist pharmacist Richard Lyness, gives us a quick guide to HRT and presents the relative risks and benefits associated with it.
WHAT IS HRT?
All types of HRT (hormone replacement therapy) contain oestrogen to replace that which is no longer made by your ovaries after the menopause. However, if you take oestrogen on its own, this can cause the lining of the uterus to build up, which can increase the risk of cancer of the uterus. For this reason, another hormone, progestogen, is also given (taking prgestogen greatly reduces the risk of uterine cancer). You do not need to take progestogen if you have had a hysterectomy.
WHAT ARE THE BENEFITS OF HRT?
HRT is effective in relieving symptoms of the menopause including hot flushes, night sweats, mood swings and depression, tiredness and poor concentration. In most cases, using HRT for a short period of time is enough to relieve these symptoms, although they may recur for a short term after stopping HRT
Long-term benefits include a reduction in the risk of osteoporosis (‘brittle bones’) and bowel cancer
WHAT ARE THE RISKS OF HRT?
As already mentioned there has been a lot of publicity about the dangers of HRT and it is important to keep these ‘scare stories’ in perspective. While there is no doubt that HRT, like the majority of medical therapies, does have side-effects the numbers of women affected are likely to be much less than we have been led to believe.
Facts and figures about the health risks of HRT can be hard to understand. The easiest way to keep it in context is to compare one group of 1000 women who do take HRT with a similar group who do not take it. The risk will be seen as the extra number of cases of each condition that are caused as a result of taking HRT.
It is important to remember that any of these conditions can occur even if HRT is not being taken and other factors such as lifestyle and family history can contribute to the risk. The extra risk of developing a serious health condition as a result of taking HRT is typically smaller than the health risks associated with smoking or being very overweight.
The side effects associated with taking HRT can vary from the relatively minor such as nausea, weight gain and fluid retention to the more serious health risks such as breast cancer and blood clots.
HEART DISEASE:
It was previously thought that HRT was actually beneficial in the prevention of heart disease but some studies have contradicted this and shown that there is and increased risk. The current thinking is that HRT does not prevent heart disease; if you are currently taking HRT and experience episodes of chest pain, stop HRT and consult your doctor.
STROKE:
There is evidence that taking HRT can result in about 1 extra case (per 1000 women) over a 5 year period. This risk will increase with age. You should stop HRT and consult your doctor if you experience migraine type headaches, unusual faints or weak limbs.
BLOOD CLOTS:
The risk of harmful blood clots (or DVT) can be increased by HRT, especially during the first year of treatment, with this risk also increasing with age. For women in their 50’s about 4 extra cases will be caused by HRT and for women in their 60’s the number of extra cases increases to 9. (This is based on taking HRT for 5 years). Stop taking HRT if you experience a red, swollen or painful leg or you have sharp pains in your chest accompanied with breathlessness.
BREAST CANCER:
The risk of developing breast cancer is different according to the type of HRT you are taking, with the risk being higher with combined therapy (oestrogen and progestogen) as compared to oestrogen alone.
e.g. for women who start oestrogen only HRT at age 50 and take it fir 5 years there will be an extra 1-2 cases per 1000 women. If they take it for 10 years an extra 5 cases would be seen.
By comparison, for women who start combined HRT at age 50 the there will be an extra six cases of breast cancer after 5 years taking HRT and an extra 19 after 10 years use. It is important that you attend breast screening (if you are over 50 you are entitled to a mammogram once every 3 years) and you should make an appointment to see your doctor if you notice any changes to your breasts including skin changes, nipple changes or lumps.
Other risks associated with HRT include an increase in endometrial and ovarian cancer. This is associated with oestrogen only HRT.
SO SHOULD I TAKE HRT AND FOR HOW LONG?
Each case should be considered on an individual basis and it is up to the women in question to choose the best treatment for her. You should make an appointment to see your doctor and discuss the options available to you and make sure the benefits can be balanced against any risks.
AS A GENERAL RULE:
FOR SHORT TERM TREATMENT OF MENOPAUSAL SYMPTOMS: The balance of risks and benefits is probably in favour of HRT. Many women are willing to accept the low risk of adverse effects of short term HRT use (1-3 years on average) in order to be free of troublesome menopausal symptoms. The lowest dose possible, that keeps the symptoms away, should be taken and many women find that after 3 years the HRT is no longer needed.
TO HELP PREVENT OSTEOPOROSIS: HRT is not considered a ‘first-line’ treatment to prevent bone – thinning. This is because HRT would need to be taken for at least 5-10 years to see any bone benefits and this longer- term use is, of course, associated with increased health risks and adverse effects. The risk/benefit balance is, therefore, not in favour of HRT and you should discuss with your doctor other treatment options and lifestyle changes.
HRT may be an option if you are unable to use other treatments or if you have already tried these alternatives and they have not worked.
FOR HEALTHY WOMEN WITHOUT SYMPTOMS AND MENOPAUSE STARTING AT AROUND AGE 50: HRT is not usually advised as it would be of little benefit.
FOR EARLY MENOPAUSE: Long term HRT may be advised until the age of 50 to prevent osteoporosis and ease any menopausal symptoms that may occur. There is an increased risk of osteoporosis associated with an early menopause and the health risks of HRT are not thought to apply, or are very small, until the ‘normal’ age of onset of the menopause (usually around the age of 50)
WHAT ARE THE ALTERNATIVES TO HRT?
LIFESTYLE: Some women find regular exercise, sleeping in a cooler room, lighter clothing and reducing stress can reduce the number of hot flushes. Spicy foods, caffeine, smoking and alcohol should all be avoided.
PROGESTOGEN TABLETS: The hormone progestogen can reduce flushing in some women, though not usually as effectively as oestrogen, and it has fewer associated health risks.
CLONIDINE: This may reduce flushing symptoms but it can cause side effects such as dry mouth, dizziness and nausea. It is only available on prescription from your doctor.
PHYTO-OESTRGENS: These are natural substances, found in plants, which act like oestrogen in the body, when digested. Symptoms such as hot flushes and mood swings can be relieved and there may be an improvement in bone strength and density. Phyto-oestrgens can be obtained from the diet by eating Soya foods such as tofu and Soya milk or it may be bought from your pharmacy in the form of a nutritional supplement. Forms available include:
RED CLOVER this is another form of plant oestrogen but ask your pharmacist for advice before taking as it can thin the blood so may be unsuitable if you are taking other medication.
BLACK COHOSH. This is one of the most promising herbal remedies but its long term effects are unknown and it should always be used as an alternative to HRT and not in addition to it.
Other potentially useful supplements include dong quai, evening primrose oil, sage, vitamin E and ginseng. Always ask your pharmacist for advice to help you find the most appropriate product
NON- HRT OPTIONS FOR PREVENTING OSTEOPOROSIS
REGULAR WEIGHT-BEARING EXERCISE – This includes brisk walking, aerobics, dancing and running
Exercise is effective as the pulling and tugging on bones by muscles helps to stimulate bone-making cells and strengthens bones.
EAT A DIET RICH IN CALCIUM AND VITAMIN D – Include at least 1000mg of calcium in your diet (e.g. a pint of milk and 2oz of hard cheese) or take a dietary supplement of calcium and Vitamin D.
Other effective measures include stop smoking, cut down on alcohol and discuss other medication options with your doctor.
