Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) - An Overview

Although Hormone Replacement Therapy (HRT) first became available more than thirty years ago, many women today are still very concerned about the long-term effects this treatment may have. Presently, only 1 in 6 Australian women who have experienced a natural menopause are on HRT.

There appears to be two main factors why many women are opting not to use HRT. The first is the knowledge that menopause is the normal physiological process which all women go through and therefore should not be treated with medication but dealt with naturally.

The second reason why women are afraid of using HRT is the lack of information available to them. All women want to make an informed decision especially when it involves something as important and delicate as our health.

Menopause is the time in a woman's life when hormonal changes cause menstruation to cease permanently. Generally, menopause can occur between the ages of 45-55 but this can differ from female to female. It is estimated that 40 million women will reach menopause in the next 20 years.

HRT was designed to combat and alleviate the symptoms of menopause, which for many, prove far too uncomfortable to bear. Each woman experiences menopause differently and symptoms may vary from individual to individual. According to research, fifteen per cent of women have minimal discomfort while others experience moderate (70 per cent) or severe (15 per cent) problems.

Symptoms of menopause can include hot flushes, night sweats, insomnia, mood swings, headaches, irritability, urinary frequency and vaginal dryness. The dryness of tissue surrounding the vagina and urethra may cause pain during sexual intercourse or urination.

HRT is used to "replace" a woman's depleting hormone levels. It is oestrogen, with or without progesterone, taken in various ways to replace or compensate for the oestrogen the ovaries are no longer producing. HRT is available in tablet, cream, implant, patch or gel form. It is taken in two main ways - to produce or to not produce a period. This will depend on the lifestyle of each woman and what they decide is the best course of action.

HRT is used to treat women before, during (peri) and after (post) menopause. As menopause is a natural and gradual process, there is no strictly defined time when HRT treatment should commence.

Another hormone that is sometimes used with HRT is testosterone. This is a male hormone, which is also produced by the ovaries and the adrenal glands (small glands above the kidneys). The use of this hormone increases energy and sex drive. However with all hormone treatments, there are side effects including hair growth, voice changes and acne.

While HRT can have beneficial effects there are also some risks associated with this form of therapy. Therefore it is important that women weigh up the positives and negatives before agreeing to be placed on HRT.

Benefits of HRT

- HRT provides the immediate relief of the uncomfortable symptoms most often associated with menopause. It decreases vaginal discomfort by increasing the thickness, elasticity and lubrication of the vaginal tissue. The same benefits can be applied to the urinary tract tissue as HRT reduces the incidence of stress incontinence and urinary tract infections.

- Studies have shown that HRT can improve mood and decrease the occurrence of depression in some women.

- HRT works to prevent bone loss in menopausal women. The likelihood of developing osteoporosis increases after a woman's body stops producing oestrogen on its own. Osteoporosis is a major cause of ill health in older women.

- HRT reduces a woman's risk of serious coronary heart disease by 50 per cent. Coronary disease can lead to a fatal heart attack. Oestrogen replacement influences the levels of blood cholesterol by boosting the "good" type (high-density lipoproteins) and lowering the "bad" type (low-density lipoproteins). Women are at a much higher risk of having a heart attack once they complete menopause.

- Preliminary research indicates that the risk of Alzheimer's disease might be reduced by HRT. However more research needs to be carried out in this area before any concrete conclusions can be drawn.

Risks of HRT

Risks will vary depending on a number of different factors - the type of treatment prescribed; the duration of treatment and whether a woman has undergone a hysterectomy (an operation to remove the uterus and ovaries).

- There is an increased risk of deep vein thrombosis (clots in the vein) in the first year of HRT. Research has found that some women on HRT experience a higher incidence of thrombosis than women who are not receiving the treatment.

- If oestrogen alone is taken by a woman who has not had a hysterectomy, there is an increased risk of endometrial cancer. That is why it is strongly recommended by medical practitioners that women take both oestrogen and progestin if they still have their uterus. Only women who have had a hysterectomy are required to take oestrogen on its own.

- For many women, their major fear of HRT is the risk of breast cancer. There have been many studies carried out to find if there is a link between HRT and breast cancer but so far most studies have proven inconclusive. The studies point out that the use of HRT over a five-year period carries no increased risk of breast cancer. After five years, the studies vary in their conclusion. There is also no evidence to suggest that a woman with a family history of breast cancer will have an added increased risk of developing breast cancer if on HRT.

- Ovarian cancer is another risk that has been associated with HRT. Although results of past studies have not shown a clear link between the use of HRT and ovarian cancer, two major long-term studies have suggested there may be an association between the use of HRT after menopause and an increased risk of ovarian cancer.

There are some women who are unable to take HRT. These include women who have had hormone dependant cancers such as certain types of breast cancers and ovarian and uterine cancer. As well as a small percentage of women who are susceptible to clotting.

Side Effects of HRT

Side effects of oestrogen include breast tenderness, edema, nausea and headaches. Progestins may cause fluid retention, acne, premenstrual-like symptoms, anxiety, depression and irritability. These side effects typically occur in the initial stages of treatment but usually subside. Irregular bleeding and weight gain are two side effects that may persist longer.

Before planning any form of medical treatment, it is imperative that women consult their general practitioners and gather as much information as possible to help them make an informed and comfortable decision.


- Annemarie Failla