Menopause and Hormone Replacement Therapy

Hormone replacement therapy (HRT) does exactly what its name suggests – it replaces the hormones that a woman’s body ceases to produce after the menopause.

Eternal youth

HRT has been touted as an ‘elixir of life’, a magic potion that can reverse the effects of ageing, keeping a woman young forever. HRT is not the answer to eternal youth, but it can make many women feel younger. Successful treatment of exhausting hot flushes and sleepless nights restores energy. In turn, feeling better means it is easier to take regular exercise and follow a healthy diet, both of which have their own benefits.

Critics are sceptical that the menopause requires any medical intervention and see it as a natural event that should run its own course. This is fuelled by the fact that not every woman becomes severely oestrogen-deficient after ‘the change’. Although the ovaries are the main source of oestrogen, the adrenal glands produce small amounts and oestrogen is also formed in fat. These extra-ovarian sources are insufficient to restore fertility but may be adequate to prevent the development of severe menopausal symptoms.

Fear of cancer, particularly breast cancer, is another cause for concern but studies suggest that the risks are minimal if HRT is taken for less than 10 years. Even then, the evidence for increased risk is controversial.

Many women accept these risks once they realise the benefits of HRT, although some find it hard to cope with a return of monthly ‘periods’ and the regular pill taking that many regimens require.

Progesterone protection

Although oestrogen replacement effectively relieves the symptoms of the menopause, it is not without its problems. Doctors noticed a sudden increase in cancer of the lining of the womb, the endometrium, that was clearly linked to treatment. The oestrogen was stimulating growth of the endometrium resulting in the formation of potentially cancerous cells. In a percentage of women, true cancer developed but in a form that, in most cases, responded to treatment. Fortunately, a simple means of prevention was found -a 12-day course of synthetic progesterone (called progestogens) taken each month ‘opposes’ the oestrogens creating an artificial bleed similar to a ‘period’, which expels any cancerous cells. Women who have had a hysterectomy are not at risk of endometrial cancer and can safely take ‘unopposed’ oestrogens.

Refuting myths

Many of the fears associated with HRT are due to its effects being confused with those of the oral contraceptive pill. In fact, they are entirely different.

The oral contraceptive pill contains high doses of synthetic oestrogens which are up to eight times more potent than the natural oestrogens used for HRT. These high doses are necessary to prevent the ovaries releasing an egg each   month, producing a contraceptive effect. A disadvantage of synthetic oestrogens is that they make blood more sticky, increasing the risk of clots and thromboses in veins and arteries, which can lead to heart attacks and strokes. In contrast, natural oestrogens have minimal effects on blood clotting, and the dose used for HRT is equivalent to the amount produced in the body during the normal menstrual cycle. Natural oestrogens reduce the risk of clots in arteries, so heart attacks and strokes are less likely to occur. The risk of a clot in the veins (venous thrombosis) in a woman taking HRT is the same risk as she would have during her re­productive years, although this is greater than for a postmenopausal woman who is not using HRT.

Because of these important differ­ences, women who were unable to take the ‘pill’ can safely take HRT.

Unfortunately many myths surround the use of HRT and misinformation abounds, even within the medical profession. Research shows that women obtain most of their information from non-experts, especially the media, so it is not surprising that there is so much confusion about HRT.

Menopause Guide – What Hormone Replacement Therapy Can Do for You

Most of the changes that happen to your body when your hormone production slows down can be prevented, and many others can be reversed.

Exciting scientific advances in the last fifty years have given rise to whole new groups of hormonal and nonhormonal medications for use during and after menopause. These are not remedies prescribed over the telephone or obtained over the counter, but ones that must be discussed with and carefully prescribed by your own physician and taken under your doctor’s supervision.

There is nothing new about the theory of “rejuvenation” therapy. Ancient Egyptians introduced organotherapy, or glandular therapy, and ate the penis of the ass for this purpose. Ancient Greeks and Romans changed the prescription to asses’ testicles. Early scientists of the 1800s added other ideas to that kind of treatment. More than one hundred years ago, in 1888, a seventy-two-year-old famous French physiologist, Brown-Sequard, reported that he had rejuvenated him­self by taking injections of “testicular juice.” He wrote that he achieved greater body vigor, improved bladder and intestinal func­tion, and that his wife used the testicular extract to combat feminine discomforts.

By the close of the nineteenth century, ovarian therapy started, with ovarian juice, powdered ovaries, and powdered ovarian tablets pre­scribed for surgical menopause, dysmenorrhea, and obesity. In 1926, A. S. Parkes and C. W. Bellerby, two scientists in Great Britain, extracted female hormone from an ovary for the first time. They named it estrin. A few years later, a German chemist, A. Butenandt, isolated and synthesized a pure form of estrogen and progesterone. He won the Nobel Prize for his work. Now that these hormones were available, physicians prescribed them for a wide range of women’s symptoms.

The wholesale prescription of this treatment became so popular that by the 1960s many books and articles ascribed all sorts of value to it, but did not describe any of the risks. The use of these powerful hormones escalated. Physicians and women alike were shocked when, in December 1975, scientific papers were released showing a causal relationship between hormone therapy and cancer of the uterus.

Women became afraid to use these medications. Fear, coupled with confusion and combined with a lack of comprehensive information, reigned. The only redeeming feature of this frightening dilemma was that scientists, physicians, and paramedical specialists finally began to conduct intensive research on the phenomenon of menopause. As a result, today physicians are able to reassure women because they have a fuller understanding of how menopause works. They now know much more about how the hormones function, how they can safely be prescribed, and what other forms of observation and treatment are necessary for their female patients.

While hormone replacement therapy (HRT) for postmenopausal women continues to be somewhat controversial, it is growing in popu­larity. Earlier, we described how the ovary starts to lose certain hor­mones and what happens to women as a result. Remember, too, that this hormone deficiency is more severe in some women than in others. The purpose of HRT is to make up for that deficiency. Not all women can take HRT, and not all women need to. For women who can, and who choose to, HRT holds the promise of preventing or reversing many of the negative effects on the body caused by the lack of estrogen.