What is New?
Hormone replacement therapy (HRT) was once routinely used to treat menopausal symptoms and to prevent heart disease. But its use changed abruptly when a large clinical trial found that the treatment actually posed more health risks than benefits, particularly when given to older postmenopausal women. When taken for more than 5 years, HRT increases the risk of breast cancer, a finding confirmed in multiple studies of different HRT combinations. HRT – particularly estrogen combined with a progestin, can make your breasts look more dense on mammograms, making breast cancer more difficult to detect. However, further review of clinical trials and new evidence shows that hormone therapy may be a good choice for certain women, depending on their individual circumstances.
Who can benefit from hormone therapy?
Women who experience early menopause, particularly those who had their ovaries removed and don’t take estrogen therapy until at least 45, have a higher risk of Osteoporosis, coronary heart disease, Parkinson’s-like symptoms and anxiety or depression. Despite the possible health risks, HRT is still the most effective treatment for menopausal symptoms. The benefits may outweigh the risks if you’re healthy and:
• Experience moderate to severe hot flushes or other menopausal symptoms
• Have lost bone mass and can’t tolerate or aren’t benefitting from other treatments
• Stopped having periods before age 40 (premature menopause) or experienced premature ovarian insufficiency before age 40
Who should avoid hormone therapy?
Women with a current or past history of breast cancer, ovarian cancer, endometrial cancer, blood clots to the legs or lungs, or stroke should usually not take HRT. In general, it is not recommended for women over 60. Smoking is strongly discouraged. Women who aren’t bothered by menopausal symptoms and started menopause after age 45 do not need hormone therapy to stay healthy. Instead, talk to your doctor about strategies which might include lifestyle changes and medication. Keeping cool, limiting caffeinated beverages and alcohol, and practising deep breathing or relaxation techniques can also be very helpful. Alternative approaches such as tai chi, yoga and acupuncture can be tried. For vaginal dryness or painful intercourse, a lubricant may provide relief.
The bottom line: Hormone therapy isn’t all good or all bad
To determine if HRT is a good treatment option for you, talk to your doctor about your symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years. As researchers learn more, recommendations may change.
For further enquiries, please contact:
Dr. A S Arun MD DNB CCST, FRCOG, FRANZCOG
Waikiki Specialist Centre
221 Wilmott Drive, Waikiki WA
Phone 9550 0300
Fax 9592 9830