OPTIMAL HEALTH |
Hormone Replacement for Women |
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Conclusion from 'A critical Look
at the Studies on Women's Hormone Therapy' ESSM Issue 21 In the management of the menopause transition, it is imperative to evaluate each woman as an individual, with her unique set of symptoms, risk factors, concerns and philosophies. It is essential to have in in-depth and honest discussion about the potential risks and benefits so that each woman can make her own informed decision. While WHI (Women's Health Initiative) has raised a lot of concerns about potential harm of HT, the study validity has been a topic of heated debate. It is important to keep in mind that WHI does not really give us the answers regarding the use of HT in women who are in the menopausal transition and who need to make the decision whether to use HT or not. Moreover, WHI results should not be extrapolated to other forms of HT including bioidentical hormone therapy. HT is only a part of the whole menopause management. It alone cannot be expected to be the 'magic bullet' to maintain youth and optimize health. It is important that we use the 'whole-person approach' and address lifestyle issues, such as nutrition, exercise, stress reduction, as well as sleep adequacy and quality. I look at menopause as an opportunity to review a woman's health status (Huang, in press). Menopause is a good time to make a cohesive action plan to prevent disease and optimize quality of life. To Take or Not to Take - Dr Michael Perring A woman's decision to take or not to take HRT is often made on the basis of the balance of benefits and risks. These vary between individuals, and change over time. Hence the need for a woman and her doctor to review periodically whether the reasons for taking hormones remain valid. It is, most importantly, individual choice. The risk of breast cancer is greater when there is a family history of the problem. The longer HRT is taken the greater the risk: used early in the menopause for up to one year it is not associated with an increased risk, and is the best way to treat menopausal symptoms such as hot flushes, night sweats and vaginal dryness. It is a Doctor's 'duty of care' to give factual advice where patients may not have considered either the level of risk high or that treatment is justified by its benefits. Ultimately he must support his patient's decision and monitor the response to any hormones should these be prescribed. Some women may continue to benefit from long-term HRT and be protected against heart attacks and osteoporosis. Some women undoubtedly feel more energetic on treatment and have a sense of wellbeing and greater libido.
Background The term Hormone Replacement Therapy (HRT) was used after
progesterone-like substances were successfully synthesised in the laboratory and marketed
as ‘progestagens’. These progesterone-like substances enabled replacement
therapy to follow more closely the pattern of hormone production in premenopausal
women. When added to oestrogen therapy for the second half of the monthly cycle
progestagens counteract the unopposed action of oestrogens on the uterus, thereby
regularising the menstrual cycle and reducing the risk of uterine cancer. Because
the risk of uterine cancer is the justification for using progestagens they are not
considered necessary if a woman has had a hysterectomy.
Continuous therapy:
Oestrogen is given continuously and progestagens are added from the 14th to 25th day of
the cycle. A withdrawal bleed, very similar to a period, occurs within two days of
the progestagen being stopped. For convenience progestagens may be taken only at the
end of three months so that the frequency of withdrawal bleeding is reduced.
Continuous therapy maybe given using Tibolone (Livial), once the lining of the uterus has
become non-secretory (about a year after finishing periods).
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