Who should NOT take HT?

Who can benefit from HT?

Not all menopausal women need hormone therapy (HT). Only one in four experience symptoms so severe they need treatment. Secondly, not all women are suitable candidates for HT.

It’s important to remember that while menopause can be uncomfortable, it isn’t a disease. It’s a physiological reality all women go through. Many women say they feel more relaxed, wiser and more at peace with themselves once the uncomfortable bit is over.

In fact, menopause is an excellent opportunity for women to pay attention to their overall health. Take a look at your eating habits and weight. Get fitter and try to stress less. Go for the tests your doctor recommends, including cholesterol, blood glucose, thyroid function and bone-density tests. Also have a mammogram done.

HT isn’t suitable for everyone. But for those who can use it it’s a safe option – and it works.

You may be one of the women to benefit from HT if :
• Your menopause started recently,  you are younger than 60 years and suffer severly from hot flushes and other menopausal symptoms.
• Your menopause started recently, you are younger than 60 years and suffer severly from hot flushes and other menopausal symptoms, and are at risk for hip fractures. You may benefit from HT combined with anti-osteoporosis drugs.

Should symptoms persist past 60 years of age, the woman will need to discuss with her doctors the benefits vs the risks of staying on therapy.

The management of of high lipid levels need to be addressed by appropriate diet, lifestyle and statin management.

Premature menopause ( before 45 years of age) should be treated to prevent the changes that occur due to the lack of hormones happening too early. Studies show that this prolonged exposure to hormones does not increase breast cancer risk or any other risks ( besides clots – see above). Once the natural age of the menopause is reached , the risks are the same as for any other woman.

Who should NOT use HT?

HT is not suitable for the following women:
• If you have a personal or family history of blood clots, stroke or breast cancer.
• If you’re older than 60 and you’ve never taken HT before.
• If you have a family history of breast cancer or a personal history of breast lumps, you should not take combined oestrogen and progestin therapy.
• If you have a family or personal history of or increased risk for heart disease, stroke, deep vein thrombosis or hypertension. If you have elevated cholesterol or lipid levels you should not take combined oestrogen and progestin therapy, but talk to your doctor about statins as studies show women are under-treated in this regard. HT is not recommended for the prevention of heart disease in post-menopausal women, according to the American College of Obstetricians and Gynaecologists. 

Reviewed and updated by Dr Alan Alperstein, obestetrician and gynaecologists in Cape Town, in February 2011. 
Previously partly reviewed by Dr Mike Davey, President of the South African Menopause Society & Dr Tobie de Villiers, gynaecologist and committee member of both the South African Menopause and International Menopause Societies.