If HRT is so effective why don’t more people take it? First, not everyone needs it; second, not everyone wants to take it; third, a small number of women should not take it; and finally, many women who would benefit from it are concerned about risks and side effects.
It is imperative to find out the facts before you decide about any form of treatment. Women’s magazines often prove to be the most important source of information on hormone therapy but they do not always get it right. In one questionnaire more than 50 per cent of women expressed an opinion that HRT increased the risk of heart attacks, strokes, breast cancer and cancer in general. Furthermore, many women starting HRT discontinued treatment within the first three months because of side effects – return of ‘periods’, feeling bloated, weight gain, nausea, breast tenderness and headaches.
What many of the magazines do not discuss is all the benefits of HRT -relief from menopausal symptoms, and reduction in risk of fractures, heart attacks and strokes; although cancer can occur, the risk needs to be put into perspective. Similarly, many of the side effects experienced settle down after the first few months of treatment or respond to simple adjustments of dose or a change of hormones.
It is also important to have realistic expectations; if HRT does not work, it may be because the dose of hormones is too low but it could be that oestrogen deficiency is not the sole cause of all the symptoms.
All these problems need to be addressed before starting HRT to ensure that treatment is not discontinued for the wrong reasons.
Cancer of the womb (endometrial cancer)
Early HRT treatment schemes were associated with a fourfold increase in the risk of endometrial cancer. Oestrogen replacement therapy thickened the lining of the womb, which could subsequently turn cancerous. Although the survival rates of this special type of cancer were very high (99 per cent at five years) the risk of developing cancer increased with each year of oestrogen use.
A breakthrough in research showed that ‘opposing’ the oestrogens with the addition of progestogen cycles created a ‘period’ which effectively removed the lining of the womb and any potentially cancerous cells.
Further studies have confirmed that an adequate dose and duration of treatment with progestogen reduce the risk of endometrial cancer at least to that of non-HRT users, if not lower.
Ovarian and cervical cancers
Both these cancers are more common than endometrial cancer but there is no evidence that HRT has any beneficial or detrimental effect, nor is having these cancers a reason to withhold HRT.
Venous thrombosis (blood clots in veins)
Modern diagnostic techniques have meant that more cases of venous thrombosis are accurately identified. For many years it has been believed that HRT is associated with little, if any, increased risk of venous thrombosis. However, recent research using these new techniques suggests that women taking HRT who have a family history or past personal history of venous thrombosis, who are overweight, immobile or who have severe varicose veins, may be more likely to develop blood clots in the veins than women who are not taking HRT. This risk appears particularly to affect women just starting HRT and, like all other risks, should be balanced against the benefits of long-term treatment.