By Dr David Delvin

HRT - What are the Risks?

Are you on Hormone Replacement Therapy (HRT)?

Or are you thinking of going on it?

If so, I urge you to read this article. Recently, the situation regarding HRT has altered in dramatic fashion. To put it bluntly, Hormone Replacement Therapy has turned out to be far riskier than we thought.

Yet I’m amazed to find that many British women are completely unaware of this fact! Only the other day, a lady of 55 said to me: ‘HRT’s so wonderful, isn’t it? I’m going to take it till I’m 90!’

I had to explain to her that this WOULDN’T be a very good idea – because of what we now know about the dangers of these hormones.

So what are these dangers? Summing up, research during the last few years has revealed that:

• HRT makes women more likely to get breast cancer;
• HRT makes them more likely to have strokes;
• HRT makes them more likely to have heart attacks (‘coronaries’);
• HRT makes them more likely to get clots in their legs or their lungs;
• One type of HRT makes you more liable to cancer of the ovary – and of the womb.

Now all of this is in marked contrast to what we’ve all been told about HRT over the years.  For decades, enthusiastic articles in the newspapers have told women how wonderful Hormone Replacement Therapy was. And we doctors have been bombarded with adverts which suggested that HRT was the best thing since sliced bread.

Indeed, the publicity for HRT has always suggested that women who take it are LESS likely to get serious illnesses like coronaries. I’ve presented medical TV programmes in which I’ve often been assured by guest experts that Hormone Replacement Therapy is ‘natural’ and ‘very safe’ and ‘reduces the incidence of heart attacks.’

Now it turns out that all of this was untrue …

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BUT ISN’T THERE A GOOD SIDE OF HRT?

So can we say anything GOOD about Hormone Replacement therapy? Yes, we certainly can.

There’s no doubt that:

• HRT is brilliant at curing ‘hot flushes;’
• HRT is very good for treating ‘night sweats;’
• HRT is excellent for treating vaginal dryness.

Indeed, millions of women are grateful to it for helping them get through the menopause without disabling and distressing symptoms. Only this month, I was consulted by a lady of 53 who was having an absolutely dreadful time with attacks of night-time sweating and bouts of facial flushing. A few days on an HRT tablet soon put her right – and she will continue on the same tablet for a little while.

But in view of the latest findings, I strongly  advised her ONLY to take the Hormone Replacement Therapy for the next  few months – and then to come off it. These days, staying on HRT for many years is a real ‘No-No.’

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THE MENOPAUSE

But let’s get back to basics for a moment. Why should women actually NEED HRT at all?

Well of course, it’s because of the menopause – the famous ‘change of life.’

What is it? It’s the time when the periods stop – which on average is about 47 to 53. At that point, there is a drop in your ‘output’ of female hormones. If the drop is fairly sudden, then you will probably experience those distressing menopausal symptoms: hot flushes (known in America as ‘hot flashes’), pouring perspiration, and vaginal dryness (which tends to make intercourse uncomfortable).

But it is important to realize that many women don’t get ANY of these symptoms – and are lucky enough to sail through ‘the change’ without any problems are at all.

(There are other symptoms which some women experience and which are often blamed on the menopause – like exhaustion, depression and loss of sexual desire. However, research suggests that these more emotional complaints may not really be due to a fall in hormone levels.)

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SO WHAT DOES  H R T ACTUALLY DO?

HRT makes good the deficiency in your female hormones. So it restores your hormonal balance to something very like it was before you entered the menopause. Therefore, you can expect an HRT product to take away pretty well all unpleasant menopausal symptoms.

If the first brand of HRT which you try DOESN’T make your symptoms better, then you should definitely switch to another one. What a lot of women don’t realize is that there are in fact no less than FORTY-SIX different Hormone Replacement Therapy treatments now available in Britain! They come in various forms:

• Tablets;
• Skin patches;
• Implants (under the skin);
• Vaginal preparations (including creams, pessaries and a hormone-releasing ring).

Since HRT came in – back during the 1960s – these preparations have helped huge numbers of women get through the ‘difficult months’ of the menopause.

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SO WHAT WENT WRONG WITH HRT?

Until the early years of this century, the outlook for HRT looked pretty rosy, though some doctors kept warning women about the possible dangers of cancer – particularly breast cancer. On this site, we issued a strong warning about it in 2000 and 2001.

Then came a bombshell. In the USA, a massive research project had been going on for many years. It was called ‘The Women’s Health Initiative’ (WHI), and it involved over 160,000 women. The idea was to examine the health benefits of HRT.

But in 2002, the organizers of one section of the study made an urgent public announcement. They were pulling out of the trial, because it was already clear that ‘the health risks of HRT exceed the health benefits.’

Their main cause for concern was the fact that they’d found a 26% increase in breast cancer among women on HRT.

In 2004 came a further blow. Another section of the study was being carried out on females who had had a hysterectomy. This too was stopped because of various health risks – notably an increase in the incidence of strokes.

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WHAT ARE THE VARIOUS DANGERS?

So let’s sum up what the dangers are now known to be:

• HEART DISEASE:   It used to be claimed that heart attacks were less common in women on HRT. The WHI trial has shown that this isn’t true. It found that ‘coronaries’ are actually 29% HIGHER in women taking the standard type of HRT.
• STROKES:  The HRT trial showed a 41% increase in strokes among women taking the commonest variety of HRT.
• BLOOD CLOTS:  The WHI study showed that in every 10,000 women taking HRT, 34 will develop clots in the legs or lungs. In a similar group of women who are NOT taking HRT, only 16 would get clots.
• BREAST CANCER:   WHI found that in every 10,000 women taking standard HRT, 38 would develop breast cancer. In 10,000 women who are NOT taking HRT, the number would be only 30.
• OVARY CANCER:  The WHI study found that women who used ‘oestrogen-only’ HRT were much more likely to get ovarian cancer. However, that form of Hormone Replacement Therapy is fairly unusual in the UK.

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BUT WEREN’T ANY GOOD POINTS REVEALED IN THE STUDY?

Yes. The WHI trial found that:

• Women on HRT have a 37% LOWER risk of getting bowel cancer – this is quite unexpected good news.
• Women on HRT were less liable to ‘thin bones’ (osteoporosis). Indeed, in the WHI trial they had 34% fewer hip fractures than women who were NOT receiving hormones. However, many experts now think that this is not sufficient justification for staying on HRT in the LONG TERM (i.e. far into your 60s).

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SO WHAT’S THE SITUATION NOW?

The situation now is that it’s OK to use HRT in the SHORT TERM – in order to get rid of distressing menopausal symptoms like flushes and sweating. It’s also OK to use the hormone therapy SHORT TERM to defeat vaginal dryness – though you may perhaps prefer to take it in the form of a vaginal cream or pessary or ring.

But nowadays, official recommendations in the U K are:

• That healthy women without symptoms should NOT use HRT;

• That HRT should be used at the lowest effective dose;

• That HRT should be used for the shortest possible period of time;

• That women on HRT should be seen by a doctor at least once per year - to discuss whether it is a good idea to continue

Rather disturbingly, many women are still not aware of these recommendations.

Equally disturbingly, there are some websites dedicated to ‘The Menopause’ which make NO reference at all to the adverse effects of HRT!  Strange, eh?

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WHAT SHOULD I DO?

If you’re on HRT, go to your GP or gynaecologist fairly soon, and ask her:

·        Whether you  are on the lowest possible dose of  HRT;

·        Whether you still need to take it;

·        How soon you could reasonably come off it.

The doctor should also give you helpful advice about diet, exercise and other aspects of your lifestyle – so as to keep you fit and healthy throughout your post-menopause years.

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Q.  I have been on HRT for 16 years. I’d like to stop, but how do I know that my nasty hot flushes have gone away?

A. They almost certainly have – after all this time! But the only way to find out is to stop the HRT for a while, and see what happens.

Q.  I understand that, unlike several of my friends, I am on ‘oestrogen-only’ HRT.  Is this a safer type?

A.  No. In the UK, most women – unlike you -- take oestrogen COMBINED with a balancing hormone called a ‘progestogen.’ The main idea of giving a combination is to protect the womb against cancer, caused by the oestrogen. So if you still have your womb, you should not be on an ‘oestrogen-only’ preparation.

Q.  Is it OK to take NATURAL products – like herbal remedies -- instead of HRT?

A.  Sure. A lot of women are doing this now. However, I can’t guarantee that the natural products will work. If in doubt, take the advice of a naturopath or herbalist who is expert in the use of such supplements. 

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Q.  I have been a smoker for 50 years. Is there any point in giving up now – or is it too late?

A.  It’s never too late to give up smoking. Even people who are 70 or 75 can get some health benefit from ‘packing it in.’ You might well prevent yourself from getting chronic bronchitis – or even lung cancer.

Q.  I’m a man of 66 and – to be blunt – Viagra hasn’t worked for me. So I suppose I’ve ‘had it,’ haven’t I?

A.  No, sir. There are now three other oral tablets which help men with erectile dysfunction (‘impotence’). They are Cialis, Levitra and Uprima. Also, there are other non-tablet ways of treating this condition. Ask any doctor for details.

Q.  What are the symptoms of prostate trouble? I think I may have it.

A.  Prostate enlargement affects a high proportion of men over the age of 55. Symptoms include dribbling, having difficulty in ‘starting,’ having to get up a lot at night, and a poor stream. If you have any if these, see your GP.

Q.  I am male, age 67, and I have to have a hip operation shortly. Any tips for getting fit, doc?

A.  Good question. It’s an excellent idea to try and get in tip-top shape before an ‘op.’

Here are some ideas:

·        Give up smoking;

·        Get some physical exercise every day;

·        Find out what your ideal weight is – and slim down to it;

·        Keep your alcohol intake to two units per day.

 Good luck!

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