CHRISTCHURCH WOMEN'S HOSPITAL
Gynaecology Services - Hormone Replacement Therapy (HT)
Hormone replacement therapy, or HT for short, is made from the hormones similar to those produced in the body before the menopause: oestrogen, or oestrogen and progestogen combined.
HT restores the levels of these sex hormones in the body to low premenopausal levels. Which is why symptoms, both physical and emotional, are relieved.
A doctor can prescribe oestrogen and/or a progestin to replace hormones no longer produced by your ovaries. This is called Hormone Replacement Therapy.
HT can be used to treat menopause symptoms to prevent bone loss. HT can be given in the following ways:
HT is very effective in relieving physical symptoms. Hot flushes should disappear within two to six weeks, and vaginal and bladder problems will improve in two or three months.
HT can improve emotional and psychological symptoms caused by menopause. Many women regain a feeling of well being. Sleep patterns are generally improved.
HT is one of the most effective method of preventing bone loss in women after menopause. Oestrogen helps bones retain calcium. As long as you continue to take HT bone loss is prevented. Over the age of 50, 150 women in every 1,000 will suffer a hip fracture. 15 of these women will die of this. Long term use of oestrogen can reduce this risk by 30 - 40%.
There is evidence that lower bowel and rectal cancers may be reduced by about 40%. Research shows no increased risk of cancer of the ovaries or cervix. There appears to be a reduction in heart disease risk among women in their 50's taking oestrogen and a progestin.
Depending on the combination of oestrogen and progestin, some women will have periods which may not be welcome. Some women may have breast tenderness, headaches, fluid retention, nausea, or weight gain. Changing the dose or type of hormones will often correct these symptoms.
Over the age of 50, 30 women in every 1,000 will develop cancer of the lining of the womb (endometrium). Three of these women will die from this disease. However the risk of developing this cancer is increased if you take only oestrogen. Therefore if you still have your womb you will usually be prescribed progestin and oestrogen so that there is no increased risk. If progestin is not prescribed you should have a sample biopsy of the lining of your womb every year.
Over the age of 50, 100 women in every 1,000 will develop breast cancer. 30 of these will die from this disease. Reports show that there is no change in risk with up to 5 years of oestrogen and progestin use. After that about 6 extra women per 1000 may be diagnosed with breast cancer. Taking oestrogen alone does not increase the risk of breast cancer. In some young women the risk may in fact, be reduced. Regular breast examinations and two yearly mammograms are recommended for all women in this age group.
The risk of developing gallstones is doubled for women who use oestrogen.
In summary, five years of HT use improves quality of life and gives bone protection without increasing the risk of breast cancer. Most women will only need HT for 2-5 years. After 5 years of use, discuss the risks and benefits with your doctor.
Who can take HT?
Most women can take HT.
If you have, or have had cancer of the breast or lining of the womb and heart problems, stroke or leg clots, you may not be able to use HT. You will need to discuss the options with your doctor.
If you have any of the following conditions you may need more regular medical checks.
If you have the following conditions it may be better to take hormones by skin patch or implant instead of by tablet;
Is Hormone Therapy recommended for all women?
In general, yes. HT is recommended for women who experience uncomfortable symptoms, as well as for those who risk developing osteoporosis (and other treatments are inappropriate).
But the decision is yours, and should be made together with your doctor.
Like any form for therapy, it may not be recommended for some women.
This is why a complete physical and gynaecological examination is recommended before starting therapy.
And why your doctor will also want as much information as possible about your family's medical history - for your own protection.
Suggested Reading List
Menopause Derek Llewellyn -Jones and Suzanne Abraham
A thought provoking book for the reader who wants to be informed but not patronised. The book covers what happens physically and emotionally, hormone replacement treatment, nutrition, sexuality and also sees menopause as an experience to be shared by women and their partners.
Women in Mid Life - Leteia Potter
This book provides the information women need to understand what is happening to them during mid-life changes. It covers attitudes towards aging, mid-life stresses and lifestyle, changes to our bodies, possible health risks, our relationships with others and with our older selves.
This was written by Contraceptive Choice, P.O. Box 31266, Milford, Auckland 9, and NI. Family Planning Association.
© 1993 Contraceptive Choice & NI. Family Planning Association.
Menopause: A New Zealand Guide - Dr Beverley Lawton