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Hormone replacement therapy (HRT)

Many doctors used to think that the quality and length of life for women was improved for most of them by going onto HRT at the time of the menopause. And few women these days seem to get to the menopause without considering taking it.

Recent research has indicated that HRT does not have the benefits of heart attack and stroke reduction that we thought. Indeed, the evidence now, is that it may even increase the risks of these things, and other problems such as pulmonary thromboembolism (rather like the oral contraceptive pill does). It also slightly increases the risk of breast cancer.

Recent authoritative medical opinion advises that HRT should be used for premature menopause or severe menopausal symptoms. Women already on HRT and over the age of 55 should consider whether they should continue or not. Discussion with a nurse or doctor would be worthwhile.

What good does it do?  It helps to keep bones strong, which will prevent them breaking if they get weak in old age (and in old age a fracture can be serious, even fatal). But HRT is no longer recommended as the best treatment or prevention. It almost always cures hot flushes, which are often a most uncomfortable accompaniment of the menopause and it is very good for vaginal problems that result from hormone lack. Many women also find it helps with memory and concentration problems that often seem to go along with the menopause.

Is there a down side? Yes of course there is. There always is! And doctors are currently rethinking whether there is overall benefit in HRT.  HRT for the first few years after the menopause has to he given in a form that usually causes regular monthly periods (unless you have had a hysterectomy). It can also cause breast tenderness and fluid retention symptoms. But for many women these are things they are used to anyway. After a few years it is possible to go onto HRT that does not cause periods. The most serious but rare side effect is breast cancer. There is a slightly increased risk of it in women who take HRT for a considerable period of time. The figures are as follows: For every 1000 women aged 50 NOT on HRT, 45 will develop breast cancer in the next 20 years, for those taking HRT for 5 years 47 will develop it, and for those taking HRT for 10 years 49 will develop it. This is the best information we have so far. We would not say these risks should be ignored, but rather that every woman should try to judge for herself what she wants. It needs to be discussed fully, but at the present time most women who are interested try it, and if they feel better for taking it they usually feel that that benefit outweighs the risks. But every woman must judge for herself.
There is also a slightly increased risk of clotting disorders such as heart attack and stroke and pulmonary embolus. This has only become clear quite recently and has changed the way many people see HRT. Doctors are now less likely to recommend HRT simply because it "does you good". Rather, see if you need it for medical reasons, and they weigh up the pros and cons. Recent reseach from America has suggested there might be particular problems with a preparation similar to the Premique brand that we use here. For this reason we are recommending a change to a different preparation if you take it.

What form does it take? Usually a tablet every day or a patch changed twice a week. There are also gels that can be rubbed on the skin daily. Most people are on tablets but patches are quite popular.