Advertorial

UK campaign for proven natural menopause treatments

A nationwide campaign in the UK for proven natural menopause treatments to be available on the NHS and recommended by GP’s and Heath Care Practitioners has been launched by French company Arkopharma Laboratories. read more

YOU ARE IN > Medical > Condition centres > Menopause > HRT

The truth about HRT

Last updated: Wednesday, December 03, 2008 Print

If you're confused by contradictory information about hormone replacement therapy, there's some new clarity: when used correctly, HRT is good for you.

According to Dr Mike Davey, President of the South African Menopause Society, effective hormone therapy is dependent on the patient’s individual profile. Age is the most important determinant when it comes to assessing benefits and risks.

It was with the publication of the 5-year WHI (Women's Health Initiative) study in 2002, a large randomised control study, that concern mounted that HRT would increase heart disease, strokes and breast cancer.

The study involved nearly 162 000 women but, critics point out, the average age of the participants was 65 years, with hormone therapy being started for the first time in women aged up to 70 years. When only women starting HRT between 50 and 59 were analysed, the incidence of heart disease actually decreased, and there was no increase in the number of strokes. Other studies have shown that the incidence of breast cancer did not increase in the first four years of HRT use.

Window of opportunity
There appears to be a window of opportunity early in menopause in which the benefits of hormone therapy far outweigh the drawbacks. Users of HRT experience improvement in their quality of life, and reap the benefits of both improved cardiovascular health and increasing bone density.

There is no specific time HRT should be stopped. It should be used for as long as necessary. As a guideline, however, the lowest effective doses should be used, and after five years an attempt can be made to withdraw HRT. If symptoms reoccur, HRT can be reintroduced at the dose that adequately controlled symptoms.

The hormones in HRT
Davey explains that HRT includes one or more of three hormones:

Oestrogen – this is the main component of hormone therapy and it controls hot flushes and night sweats, improves sexual function, increases bone density, and decreases heart disease risk in younger women.
Progesterone or progestin- this is given together with oestrogen in women who have not had a hysterectomy. This helps to protect the lining of the uterus.
Androgen (testosterone) – this may be given under certain circumstances where libido is decreased, particularly after removal of ovaries.

Osteoporosis and bone density
Davey says a good time for women to have an initial bone density test would be in their early 50s, when most of them have entered menopause. The bones of women on HRT, however, are protected, so the scan can be postponed.

If results show no cause for concern, then bone health can be maintained with a few simple lifestyle decisions, such as a correct diet, a regular exercise programme, and avoiding smoking and excessive drinking of alcohol. If, however, test results show that bone density is compromised, Davey encourages a follow-up test two to three years later.

Davey emphasises the role of a balanced diet. Low-fat dairy products are a good source of calcium; supplements could include vitamins D and B complex, and the omega fatty acids (helpful in preventing heart disease). There are, however, no adequate scientific studies to support any particular regime of supplements. Davey encourages patients to discuss any supplements and natural products they may be taking with their doctors.

(Joanne Hart, Health24, November 2008. Reviewed by Dr Mike Davey.)