Dear Readers,

LT is a 46-year-old lady who has children. As far as she is concerned, the unthinkable has occurred. Her doctor has told her that she is going through menopause! Her blood hormone levels would indicate this and she is also experiencing hot flashes. LT says she does not like the menopause experience at all. She wasn't prepared for it! She is considering the use of hormone replacement therapy (HRT) to alleviate her symptoms and to prevent her bones and skin from prematurely ageing. LT is aware that HRT has some drawbacks and asks Lifeline to comment on the use of HRT in a lady who is otherwise very active and healthy.

So-called facts

Many women are afraid to use HRT even when its use seems to be strongly indicated. This is because of various, so-called facts, which they have heard and accepted as gospel over the last few years. At this time, studies, including further analysis of the Women's Health Initiative (WHI), which first cast doubt on HRT, now seem to indicate that HRT is safe for healthy women in the early post-menopausal period and has major preventive effects against fractures.

HRT also prevents heart disease and reduces mortality in the older age group of women. For this cause, HRT is documented to improve sexuality and reduce depression, therefore increasing the quality of life in menopausal women. HRT may even reduce the risk of coronary heart disease in the early post- menopausal women. Some physicians have worried that use of HRT can result in heart attacks during the first two years of use but recent studies do not confirm this and the number of heart attacks have actually decreased with the duration of use of HRT, suggesting that HRT protects the heart and coronary blood vessels.

Whether HRT causes an increase in the occurrence of strokes, is uncertain at this time. Some studies show no increased risk while others show only a slight statistical increase in the occurrence of strokes.

Deep-vein thrombosis

One area in which some risk does occur is with the risk of deep-vein thrombosis (DVT). The risk of DVT is doubled with regular HRT but is less when the transdermal patch is used. DVT is, however, a fairly rare event in the healthy early menopausal woman. It should also be mentioned that this increased, risk of DVT is also seen in women who use the oral contraceptive pill and, therefore, should not necessarily be a deterrent to the use of HRT.

Women are often afraid of the risk of breast cancer when using HRT. There is some small increase in this risk after using combined oestrogen and progesterone for over five years. When oestrogen alone is used (in women with hysterectomies) there is no increase in breast cancer for the first seven years of use. The truth is that the incidence of breast cancer, in the otherwise healthy woman, normally increases with age.

Prevents osteoporosis

HRT is very effective in the prevention of osteoporosis and definitely reduces the risk of fractures in older women. HRT also helps to maintain the spinal cord integrity and, therefore, helps to prevent osteoarthritis.

For women who worry about memory loss as they age, HRT is thought to decrease the risk of Alzheimer's disease, especially in women who started using HRT in the early menopause.

This information should allow LT to make an informed decision about using HRT to eliminate most menopausal symptoms. The healthy menopausal and post-menopausal woman should not fear using HRT if the associated menopausal symptoms warrant its use. The risk is minimal in the healthy woman and quality and comfort in life is also very important.

Write to:

Lifeline

PO Box 1731

Kingston 8

AJM