Risks of HRT

A month ago, it was announced that hormone replacement therapy (HRT) is causing more harm than good.

The Canadian Medical Association Journal (CMAJ) reports that the Women’s Health Initiative trial involving 16,608 women aged 50 to 79, was stopped because preliminary results showed statistically significant increases in coronary artery disease, invasive breast cancer, stroke and pulmonary embolism (clot in the lungs) in women treated with estrogen plus progestin (Prempro).

According to a report in the NEWSWEEK, last year U.S. pharmacists filled some 45 million prescriptions for Premarin and an additional 22 million for Prempro. There are more than 13 million American women on HRT.

Menopause is a natural event. But the event is very troublesome to the woman who is going through the menopause and also to the husband who has to show understanding and patience to help his wife get through these difficult years.

About 60 years ago, researchers discovered that a substance from pigs’ ovaries can put off old age and relieve menopausal symptoms.

In 1940s, pharmaceutical companies started producing estrogen from pregnant mare’s urine called Premarin. Twenty years later, the drug was being recommended for women who showed evidence of estrogen lack. Practically, all women over the age of 50.

HRT has several benefits. It was prescribed to menopausal women to relieve hot flashes, prevent heart disease and osteoporosis. There were other reasons such as improvement in quality of life.

But the risks and benefits of long-term postmenopausal HRT with estrogen alone or combined with progestin have long been a source of controversy.

This has now changed. The evidence is clear that women taking combination of estrogen and progestin have increased risk of breast cancer, heart disease, stroke and blood clots in the lungs. Potentially life threatening.

There were some benefits like reduction of hip fractures, decrease in the rates of osteoporosis and colon and rectal cancers. It also alleviates hot flashes after menopause.

What happens now?

HRT should not be used for preventative measures in healthy postmenopausal women without severe symptoms. It causes more harm than good. Other methods of prevention should be undertaken to prevent chronic illnesses.

Preventive measures for heart disease are: quit smoking, exercise, control blood pressure, control high cholesterol level, and eat a healthy diet (remember ELMOSS?).

Osteoporosis can be prevented by: exercise (starting early in life), calcium and vitamin D and in high risk women use bisphophonates.

Finally, this brief article does not cover all aspects of HRT. If you are on HRT and haven’t spoken with your family physician or gynecologist in the last one month then you better find out whether you should still be on HRT. A visit to your doctor may save your life.

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