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Dr Duncan

HRT and the menopause

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I have just finished reading a very interesting article on how women differ from baboons! No, this is not some misogynistic joke, but a scholarly insight into how the female of our species is very different from other primates when it comes to menopause. It seems that whilst the female baboon may continue to reproduce well into old age - that’s 19 years for them - female humans have many decades freed from child-bearing once they have completed their reproductive lives. This leads me neatly on to the subject of menopause, what it means and what’s the best way to manage/treat it.

We humans need to reproduce in order to survive, but as the study above suggests, women only have a certain period of time during which their bodies are fertile and reproduction is possible. Then comes the transition process that we call menopause.  Which hopefully means that women can experience 30 to 40 years of healthy life when pregnancy is no longer an option.

Menopause is a normal physiological event that marks the end of menstruation and the end of egg production by the ovaries. Here in the Western world, menopause tends to happen between the ages of 50 and 52 years, yet in many parts of the world that have fewer advantages than we have here in Australia, it is often several years earlier than that. If menopause comes before the age of 40 it is then described as premature. Commonly, the menopause is accompanied by:
  •  Hot flushes
  •  Night sweats
Insomnia and can often also include:
  • Changes in mood, memory and concentration
  • Alterations in libido and dryness of the vagina.
Most women at the end of their reproductive life know that the “change” is coming and many will deal with it on their own, and usually only seek medical advice after having tried various forms of alternative treatments. For many decades the gold standard treatment for menopause has been by Hormone Replacement Therapy (HRT): but HRT has had a long and checkered history which has left most in the community, and many in the medical profession, confused and even scared about how best to use it without causing harm to an otherwise fit and healthy person!

HRT works by replacing the disappearing estrogen from a woman’s body with other estrogens and the most common form would be conjugated equine estrogens. This works well in 80% of cases and over the short term there are no problems with taking it. However, because each individual is different it is extremely important that before taking HRT, a woman should be assessed for her whole health, and any treatment or lifestyle change offered, should be tailored to the individual.

This is very important because menopause and HRT are not just about the end of the reproductive life-cycle, but must take into account  the other possible conditions such as:
  •  Heart Disease
  •  Breast cancer
  •  Osteoporosis
  •  Ovarian cancer
  •  Thrombo-embolic disease (the risk of suffering from blood clots and their effects)
All of these have to be assessed when considering HRT and the length of time HRT should be used for. But the role of HRT in managing the menopause was seriously clouded when the Women’s Health Initiative (WHI) was published back in 2002 with worldwide coverage. The report spoke of the potential for increased risks of breast cancer, heart attacks and osteoporosis etc after FIVE years of treatment with combined oestrogen and progesterone therapy (the progesterone needs to be taken by women who still have a uterus as it protects the lining of the womb from cancer). As a result of the WHI report, millions of women around the world ceased taking HRT.

Now that the controversy surrounding that report has begun to clear, some common sense appears to be returning to the subject of hormone replacement therapy. Firstly, 70% of women who take HRT will cease to have persisting symptoms after 2 years, and 80% will be free of symptoms by five years. In other words, HRT is usually not needed for five years! Secondly, while the WHI was a properly constructed, well controlled trial using HRT, it was in a group of women whose average age was in the mid 60’s, and that to my knowledge is well after the usual age of Menopause!

Menopause should not be seen in isolation, but rather as an important time in a woman’s life when all health issues should be assessed with a view to reducing the risks for future diseases such as heart disease, cancer and osteoporosis. So:
  •  Quit smoking.
  •  Get adequate, appropriate physical activity.
  •  Eat a healthy, balanced diet suited to the individual.
  •  Review, and where necessary, reduce alcohol intake.
  •  Discuss HRT options with your doctor to ensure these are tailored to your individual needs and adjusted as necessary.
Menopause is a period of transition in a woman’s life - and there will always be a number of significant transitions in any person’s life - but it is not a disease. Short term HRT will control the vast majority of women’s symptoms and treatment should be targeted at supporting the person, promoting health and minimizing any harm.

Article written by Dr. Duncan Jefferson. More articles here. For more information on health care and private health cover, visit HBF Insurance at www.hbf.com.au.

The content of these articles is not tailored for any particular individual's circumstances. The author does not take into account your physical condition, medical history or any medication you may be taking. Any advice or information provided by the author cannot replace the advice of your health care professional. The views expressed in this article are those of the author and do not represent those of HBF unless clearly indicated.

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