Who Benefits from HRT?

There are two main reasons why you may wish to take HRT. First, you may want to obtain relief from hot flushes, night sweats, sleepless nights, depression, painful intercourse, bladder problems and other symptoms of the menopause. However, you do not need to have symptoms to benefit from HRT. The second, and probably the more important, reason to take it is the protection that it provides against increased risks of osteoporosis and heart disease associated with post­menopausal oestrogen deficiency.

HRT for menopausal symptoms

These often rapidly respond to HRT, sometimes within a few days, although it can take longer for the hot flushes to settle down. It does not matter which type of oestrogen replacement you take, providing the amount is sufficient to relieve symptoms.

Protection against osteoporosis and heart disease

About 15 years after the menopause, fractures and heart attacks increase because oestrogen levels are insufficient to have a protective effect. Ideally, substitute protection against these conditions needs to start as soon as the levels of oest­rogen fall.

This will be around the age of 50 for the natural menopause but may be earlier if you have had a hysterectomy or an early menopause.

Risk factors for osteoporosis

– Age

– Alcohol intake

– Bed rest

– Caffeine intake

Diet lacking in calcium

– Early menopause

– Family history

– History of amenorrhoea

– Lack of exercise

– Little exposure to daylight

– Number of years since menopause

– Number of pregnancies

– Oral contraceptives

– Previous fracture(s)

– Racial origin: white women are more susceptible than black

– Smoking

– Thyroid overactivity

– Use of oral steroids

Risk factors for heart disease

– Age

– Alcohol intake

– Diabetes

– Early menopause

– Family history

– High blood pressure

– High cholesterol

– Lack of exercise

– Number of years since menopause

– Oral contraceptives

– Personality

– Previous heart attack

– Smoking

Doctors currently recommend between 5 and 10 years of treatment with HRT for therapy to be of sustained value. Longer-term use would probably provide greater protection, but this needs to be balanced against an individual’s tolerance of HRT and associated risks.

The decision whether or not to take long-term HRT can only be made by assessing the balance of your individual risks versus possible benefits. The benefits of HRT will depend on your personal circum­stances, and your individual risk of fractures or heart disease.