New Guidelines for Hormone Replacement Therapy

In 2002, we learnt that in post-menopausal women, hormone replacement therapy (HRT) with estrogen was doing more harm than good. The study, Women’s Health Initiative trial, involved 16,608 post-menopausal women, aged 50 to 79. Because of these findings, the study was discontinued early.

The harmful effects of estrogen therapy were: 41 percent increase in stroke, 29 percent increase in heart attacks, doubling of rates of blood clots in the legs and lungs, 26 percent increase in breast cancer and 22 percent increase in total cardiovascular disease.

But the report also said HRT has benefits: 37 percent reduction in cases of colorectal cancer, 33 percent reduction in hip fractures, no difference in total death rate from all causes and controls hot flashes.

Women have been taking estrogen to relieve post-menopausal symptoms for many years. 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. But things changed after 2002. According media reports, the highly publicized research led to a sharp drop in HRT prescriptions, to about five million prescriptions last year from 12 million in 2002.

The new guidelines from the Society of Obstetricians and Gynaecologists of Canada say hormone replacement therapy is safe and effective when used immediately at the onset of menopause and for a relatively short time. That means it would be safe to use HRT in women in their 50s to relieve their hot flashes, night sweats and vaginal dryness. And they should discontinue using HRT within five years.

The new guidelines were announced after a committee of experts re-examined the data from the previous study and came to the conclusion that the age at which women begin taking HRT, the dose and the duration all have an influence on risk. The guidelines do not endorse the use of complementary therapies as there is little or no evidence that herbal products sold for the treatment of menopausal symptoms have any benefit.

Women are advised to take control of their lives. Many problems (mood swings, insomnia, osteoporosis and difficulty concentrating) can be alleviated with lifestyle changes – weight control, healthy eating, exercise, no smoking, stress relief and meditation.

So, what should women do now? Why do experts change their minds about such things? First they create a panic then it takes them seven years to come back and say you are ok to take it within certain limitations.

I guess that is the nature of medical science. There is so much we know and again there is so much we do not know. Physicians find this as frustrating as the general public. Some women are going to be quite upset, may be even angry and frustrated, that they were deprived of HRT when they needed it. But it is never too late to sit down with your doctor and discuss your symptoms and indication for HRT.

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