Medical cycles

By: Dr Peter Hall

Medicine goes in interesting cycles. Twenty years ago my practice nurse and I used to run menopause seminars at which we strongly promoted hormone replacement therapy.

Besides the benefits for hot flushes and bone strength, we presented evidence  that HRT could reduce heart risk considerably. Then a large Women’s Health study came out in 2002 in which it was reported that HRT increased heart disease and strokes, as well as breast cancer. Suddenly our ‘wonder drug’ wasn’t so wonderful any more and we backed off its use massively.

So, for a decade or more, we were restricted to some non-hormonal therapies of modest benefit and a plethora of natural remedies, none of which are scientifically proven.

But a long term review of the Women’s Health study has shown that its results were misinterpreted and that HRT is, after all, a very safe and effective option for many women.

I’m pleased to say that we are now back in the business of helping women through this stage, with significant benefit to quality of life.

It is interesting to note that a postmenopausal life at all is a modern phenomenon. The average life expectancy for a woman in the UK in 1900 was about 50 years. Of course this was skewed by infant mortality, but in effect there weren’t a huge number of women living longer and suffering the effects of oestrogen deficiency. Compare that to today, when a woman may expect to live a third of her life after her ovaries have retired. And in the transitional period, about 75 percent of women have some symptoms, predominantly hot flushes, but also sleep disturbance, vaginal dryness, loss of libido, mood swings and the other problems mentioned above.

Unfortunately there is some bad news here – for a small proportion of women these symptoms are ongoing in their 60s and 70s, which they find intensely frustrating.

For women who have a hysterectomy they have the simple option of replacing oestrogen only. As long as there are no contraindications and the dose is correct, they will do well.

Along with all the other women, they need to keep up their breast and cervical screening and choose a healthy lifestyle and diet. If the womb is still present, unopposed oestrogen runs a risk of thickening the uterine lining and endometrial cancer. Therefore, it has to be balanced by some kind of progestogen, either on a cyclical basis (so the woman still has periods) or in a continuous combined form which usually dries up the periods after a few months. Either way, it’s worth a GP consult and you might like to check out this excellent website: jeanhailes.org.au

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