HRT, also known as hormone therapy or HT, is medication containing hormones that a woman’s body stops producing after menopause. HRT is used to treat menopausal symptoms.
While HRT reduces the likelihood of some debilitating diseases such as osteoporosis, colorectal (bowel) cancer and possibly heart disease, it may increase the chances of developing a blood clot (when given in tablet form) or breast cancer (when some types are used long-term).
For women who experience menopause before the age of 45 (early or premature menopause), HRT is strongly recommended until the average age of menopause onset (around 51 years), unless there is a particular reason for a woman not to take it.
Menopause symptoms that may be reduced by HRT
Hot flushes and night sweats
Vaginal dryness
Thinning of vaginal walls
Vaginal and bladder infections
Mild urinary incontinence
Aches and pains
Insomnia
Cognitive changes, such as memory loss
Reduced sex drive
Mood disturbance
Abnormal sensations, such as ‘prickling’ or ‘crawling’ under the skin
Palpitations
Hair loss or abnormal hair growth
Dry and itching eyes
Tooth loss and gingivitis (gum problems).
Where appropriate, other forms of management for menopausal symptoms, such as oestrogen vaginal creams or low doses of antidepressants, may reduce hot flushes. Seek advice from your doctor.
Added benefits of HRT
HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:
Diabetes – taking HRT around the time of menopause reduces women’s risk of developing diabetes.
Osteoporosis – weakening of bones such that they break more easily. HRT prevents further bone density loss, preserving bone integrity and reducing the risk of fractures , but it is not usually recommended as the first choice of treatment except in younger postmenopausal women (under the age of 60).
Bowel cancer – HRT slightly reduces the risk of colorectal cancer (bowel cancer)
Side effects of HRT
HRT needs to be prescribed for each woman individually. Some women experience side effects during the early stages of treatment, which may include:
Breakthrough bleeding
Breast tenderness
Bloating
Nausea
HRT-related health risks
While HRT reduces the risk of some debilitating diseases, it may increase the risk of others. These small risks must be balanced against the benefits of HRT for the individual woman. Talk to your doctor about any concerns you may have.
Breast cancer
Women over 50 years of age who use combined oestrogen and progestogen (progesterone) replacement for less than five years have little or no increased risk of breast cancer. Women who use combined HRT for more than five years have a slightly increased risk. Women on oestrogen alone have no increased risk up to 15 years of usage.
There is no evidence to suggest that a woman with a family history of breast cancer will have an added increased risk of developing breast cancer if she uses HRT. The risk with combined oestrogen and progestogen is greater than with oestrogen alone or with newer HRT agents such as tibolone (sold as Livial).
Cardiovascular disease
Women over 60 have a small increased risk of developing both heart disease and strokes on combined oral (tablet) HRT. Although the increase in risk is small, it needs to be considered when starting HRT, as the risk occurs early in treatment and persists with time.
Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch. Similarly, tibolone (sold as Livial) increases the risk of stroke in women in their 60s and older.
Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more, and may have no increase in risk if treated with low doses by mouth or through the skin.
Venous thrombosis
Venous thromboses are blood clots that form inside veins. Women under 50 years of age, and women aged 50 to 60 face an increased risk of venous thrombosis if they take oral HRT. The increase in risk seems to be highest in the first year or two of therapy and in women who already have a high risk of blood clots. This especially applies to women who have a genetic predisposition to developing thrombosis, who would normally not be advised to use HRT.
Limited research to date suggests the increased risk of clots is mainly related to oestrogen + progestogen in oral (tablet) form. More research is needed to confirm that oestrogen applied through the skin (as patches, implants or gels) does not have the same effect.
Endometrial cancer
The endometrium is the lining of the uterus. Use of oestrogen-only HRT increases the risk of endometrial cancer, but this risk is not seen with combined continuous oestrogen + progestogen treatment. There is no risk if a woman has had her uterus removed (hysterectomy).
Cholecystitis
Cholecystitis is a disease where gallstones in the gallbladder block ducts, causing infection and inflammation. On average, there is a slightly higher risk that a woman will develop cholecystitis when using oral (tablet form) oestrogen or oestrogen + progestogen for five years, but patch treatment is associated with a lower risk. Treatment for cholecystitis includes surgery to remove gallstones or the gallbladder.
HRT does not cause weight gain
An increase in body fat, especially around the abdomen, can occur during menopause because of hormonal changes, although exactly why this happens is not clear. Normal age-related decrease in muscle tissue, and a resulting decrease in energy levels, can also contribute to weight gain.
Most studies do not show a link between weight gain and HRT use. If a woman is prone to weight gain during her middle years, she will do so whether or not she uses HRT. Some women may experience symptoms at the start of treatment, including bloating and breast fullness, which may be misinterpreted as weight gain. These symptoms usually disappear once the therapy doses are changed to suit each woman.
Contraception is still needed
HRT is not a form of contraception. The treatment does not contain high enough levels of hormones to suppress ovulation, so pregnancy is still possible in women who are ovulating occasionally in perimenopause. It is generally advised that menopausal women should continue to use contraception until their natural periods have ceased for at least one year if they are aged over 50, or after two years without periods if they are younger than 50.
Long-term use of HRT is not recommended
It is currently believed that, overall, the risks of long-term (more than five years) HRT use outweigh the benefits. HRT should not be recommended for disease prevention, except for women under 60 years of age with substantially increased risk of bone fractures.
No alternative therapy has yet been clinically proven to reduce a menopausal woman’s risk of osteoporosis. Some of the more popular alternative therapies include soy products, phytoestrogens and herbal medicines.
Women with liver disease, migraine headaches, epilepsy, diabetes, gall bladder disease, fibroids, endometriosis or hypertension (high blood pressure) need special consideration before being prescribed HRT, which may be given through the skin in many cases.
Despite the risks of long-term use, in women with severe and persistent menopausal symptoms, HRT may be the only effective therapy. Seek specialist advice from a menopause clinic or menopause specialist. Regular check-ups are recommended.
HRT for breast cancer survivors
Evidence has not conclusively shown that HRT will increase the risk of breast cancer recurring in a woman with a prior history of the disease. However, oestrogen and progestogens (forms of progesterone) may stimulate some types of cells in the breast and increase the risk of breast cancer in women without a history of breast cancer.
It is advisable for women with a prior history of breast cancer to avoid HRT unless other treatments are ineffective and their quality of life is made intolerable by menopausal symptoms.
Phytoestrogens and prior history of breast cancer
There is no evidence that phytoestrogens increase the risk of breast cancer recurring but, under certain circumstances, some breast cells may be stimulated. It is not recommended that women at high risk of breast cancer or breast cancer survivors take highly processed soy supplements, but eating moderate amounts of whole soy foods appears to be healthy.
Things to remember
Menopausal symptoms can be managed with support, education, lifestyle changes and HRT.
In the early postmenopausal years, HRT is an effective therapy for menopausal symptoms. In most women with moderate to severe symptoms, the benefits outweigh the small increases in risk.
The long-term use of HRT has some benefits but it also has some risks.
The decision to use HRT, and for how long it should be used, must be based on individual assessment and needs.
No comments:
Post a Comment