Hormone Replacement Therapy: is it the Elixir of Youth or is it going to kill you?
HRT replaces the lack of estrogen that is causing hot flushes and other menopausal symptoms. Older, flawed studies, especially one called “The Women’s Health Initiative Study” back in 2002 scared the living daylights out of doctors and patients alike….However, we now realise that this study was done on older women taking older types of HRT. More modern HRT is safer, especially if given in more carefully selected women without heart disease or uncontrolled hypertension.
So, what are the Real Benefits and Risks?
Myth /Benefit: CANCER
If we give a Woman who has a womb systemic oestrogen, without progesterone, this can increase her risk of future cancer of the womb. However, this is not something we would do: All women with a womb must be on some form of progesterone if they are taking systemic oestrogen. This progesterone can be in tablet form, or in the form of a Mirena IUS. Progesterone is not well absorbed through the skin, so we do not advise that it is taken this way. The only oestrogen we can give without progesterone if you have a womb is vaginal oestrogen.
People worry about HRT causing Breast Cancer. HRT does very slightly increase the risk of breast cancer if you take it over the age of 50, for more than 5 years. However, this risk is very small, and it is the similar to the increased risk of Breast cancer if you drink 3 or more drinks per night. It is lower than the increased risk of breast cancer if you are overweight. The risk is also higher with combined HRT and some of the older progesterones. Newer so called “Micronised” progesterones have a lower risk of this. The breast cancer risk falls to normal when you stop taking HRT. There is no increased breast cancer risk if HRT is taken before the age of 50. So, if you are unlucky enough to have had an early menopause and you are given HRT up to age 50, that’s ok as you are just replacing what should have naturally been there anyway.
You should also know that HRT also protects against Bowel cancer.
Myth/Benefit 2: Clots
It is true that HRT does slightly increase the risk of Deep vein thrombosis and thromboembolism. However, we know that the newer micronised progesterones are much safer.
Topical oestrogen in the form of gels/patches are also much less likely to cause a clot.
Myth/Benefit 3: Heart attacks and Strokes.
HRT may actually PREVENT Cardiovascular disease in women who start it earlier (around age 50) up to age 60 in women who are of normal weight and have controlled blood pressure. The older studies that showed an increased risk of heart attacks and strokes on HRT included women who would not be candidates for HRT now: Older Women who were very obese, with uncontrolled hypertension or known heart disease.
The newer HRT is much safer, especially if given topically as a gel or patch on the skin.
Myth/Benefit 4: Osteoporosis.
Osteoporosis is thinning of the bones. It can increase the risk of a life changing if not life-threatening hip or spine fracture when you are older. HRT can help prevent and, in some cases, treat osteoporosis.
Myth/Benefit 5: Dementia
Women who have had premature Ovarian failure should definitely have HRT unless there is a good contraindication. Not only does it help to prevent osteoporosis, but it also helps to reduce the risk of both Alzheimer’s and Vascular dementia in this group of women, who are at increased risk of this. Some women also find that HRT helps with their “Brain Fog”. Research is continuing into HRT and dementia, but at this time it would not be prescribed solely to prevent or treat dementia otherwise.
In short, there are risk and benefits to everything, but if your hot flushes are very debilitating, you can talk to your doctor about HRT to see if it is right for you.
