Relief of hot flushes
HRT definitely relieves hot flushes when used in the correct dosage. It also appears to prevent the development of hot flushes in women starting on HRT who have entered the menopause as indicated by the absence of menstruation but who have not experienced hot flushes yet.
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Treatment of problems with the bladder and vagina
As women enter menopause, the loss of oestrogen affects many parts of the body. One area which is adversely affected is the urogenital tract. The urogenital tract consists of the genital organs (ovaries, Fallopian tubes, uterus and vagina), and includes the kidneys, the ureters (bringing the urine from the kidneys to the bladder), the bladder and the urethra (the tube through which urine is passed when emptying the bladder).
The vagina, bladder and urethra also respond to oestrogen, and when the hormonal level in the body is reduced, the tissues of these organs become thinner, weaker and dry. This can lead to vaginal dryness and discomfort during intercourse.
The changes in the tissues of the bladder and urethra and the associated loss of protection against infection-causing germs may cause an increased risk of urinary tract infection, which is another problem often afflicting postmenopausal women.
HRT can provide the tissues of the urogenital tract with enough oestrogen to improve the function and to prevent vaginal dryness and recurrent bladder infections.
Prevention and treatment of osteoporosis
HRT clearly counteracts demineralisation of bone and thus prevents the loss of bone which occurs when women enter menopause.
Not only does this prevent hip and spinal fractures, but the oestrogen also acts on the teeth and jaw. This means that women taking HRT are less likely to lose their teeth once menopausal.
However, HRT alone will not counteract osteoporosis. Equally important are other measures such as regular exercises, a sensible, well-balanced diet and avoiding cigarette smoking.
In women who are at particular risk of osteoporosis or who have already developed some loss of bone density, a consultation with a gynaecologist and/or endocrine specialist is important since a combination of HRT with other bone-loss preventing drugs may be necessary.
HRT and coronary artery disease
After the menopause, a woman’s risk of coronary artery disease and other forms of vascular disease such as stroke, increases.
Research has shown that there is still a lot of controversy on the effect of HRT and coronary heart disease. There are several mechanisms which are thought to be in existence and which may reduce the risk of heart attacks in women taking HRT. One way in which oestrogens, at least partly, may do this is by affecting the cholesterol metabolism. The levels of “good” cholesterol (HDL) are raised while those of “bad” cholesterol (LDL) are lowered. This can have a positive effect on the blood vessels of the body and may prevent the development of atherosclerosis (irregular inner surface, decreased diameter and loss of elasticity of arteries), high blood pressure and coronary heart disease.
Once in the menopause, women tend to redistribute fat. This generally results in increased amounts of fat around the tummy. Obese women with this type of redistribution are predisposed to coronary artery disease, the risk of which may be decreased by HRT.
Another mechanism concerns the development of insulin resistance which is related to body fat distribution around the tummy. Insulin resistance can eventually lead to so-called Type 2 diabetes mellitus (a type of sugar disease which occurs in later life and does not require insulin injections). Even without the development of diabetes, insulin resistance will increase the chances of developing atherosclerosis. By preventing insulin resistance, HRT may reduce a postmenopausal woman’s risk of coronary artery disease.
The relationship between the prevention of stroke and the use of HRT is even more controversial. Some early studies have suggested that there is no effect on the risk of stroke. Later studies are conflicting, with some showing that the risk of stroke is decreased by HRT and others actually suggesting an increased risk of stroke in women using HRT. Further research is needed to clarify this point.
However, in spite of all these mechanisms it must be understood that not being obese in the first instance is of greater importance in the prevention of blood vessel disorders with subsequent high blood pressure, heart attacks and strokes. It does not help to be overweight and to have a sedentary lifestyle without doing any exercises and then to hope that HRT will take care of the increased risks of vascular diseases after menopause.
Can HRT improve mood and cognitive function?
Oestrogen on its own has definite effects on the functioning of the brain. It affects the growth and survival of nerve cells and the way in which impulses are transmitted along nerve fibres. It can also decrease the risk of developing of Alzheimer’s disease.
Oestrogen has a positive effect on mood, memory and quality-of-life scores in studies which have been carried out.
However, the addition of progestins, which is essential to prevent the development of uterine cancer, seems to counteract these effects to some extent. So the form of HRT, either oestrogens with progestins or ERT (oestrogens-only for hysterectomised women), is important when looking at these possible beneficial effects.
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