Hormone Replacement Therapy……Killer or Kind
relief ?
Just last week the world was rocked by sensational headlines
regarding findings by an American study that showed shocking
risks associated with hormone replacement therapy (H.R.T.).
The study was aborted five years into the trial, as the researchers
considered the risk too great for the participants of the
trial to continue taking the combined hormone (oestrogen and
progestin) replacement. 16,000 women all in there sixties
were involved in the trial.
The statistics for concern showed that in women on combined
H.R.T.:
Heart disease was increased by 29%.
Stroke increased by 41%.
Breast cancer figures rose by 26 %.
H.R.T. was shown to decrease the risk of colo-rectal (bowel)
cancer by 37%, uterine cancer 17%, and hip fractures by 34%.
Given that heart disease, stroke and breast cancer are three
of the of the largest killers of women any way, do we really
want to stack the odds against us by adding to that risk factor?
Let’s take a closer look at Menopause, HRT and the whole
shibang!
What is Menopause anyway?
Menopause is the time that women reach the end of their reproductive
years. At this time the ovaries cease to make the two hormones
oestrogen and progesterone. This is not a sudden event, but
more of a winding down process that can take a matter of years
to pass. Menopause usually happens at about 50 years of age,
but can vary between individuals. There, that sounds all pretty
straight forward doesn’t it, so why all the hoo-haa?
Oestrogen and progesterone are two pretty powerful characters.
Not only are they responsible for all that is to do with reproduction
and sexuality, but they flex their muscles in a few other
areas as well.
With decreasing levels of these hormones you can expect:
A decrease in bone density.
Mood swings.
Dryness of the skin (particularly in the vagina).
Night sweats or “hot flashes”.
Loss of libido.
Cardiac palpitations (racing heart beat).
What is H.R.T.?
To avoid some of these distressing symptoms, pharmaceutical
companies designed replacement hormones to mimic the actions
of the womans natural hormones. These drugs were meant to
make the transition through this phase of life easier, as
well as avoid some of the medical problems associated with
menopause. In fact, it was initially believed that HRT would
decrease the risk of cardio-vascular diseases such as heart
attacks and strokes; these most recent figures from the American
study show completely the opposite.
This raises some very serious questions for women that are
currently taking the combined HRT. Health practitioners worldwide
been flooded with questions from concerned women regarding
this issue. The general consensus from medical experts in
this field is that if you have been on HRT for more than 5
years, then you need to discuss the issue with your doctor.
That doesn’t really tell us a hell of a lot, it is particularly
useless when your doctor is on the other side of the world,
and the local medical practitioners here in Bali are hardly
familiar with HRT in the first place.
So what do we do now?
It really comes back to a risk versus benefit situation.
Has menopause given you symptoms that would happily have you
jumping off a cliff at times? Are you going mad with hot flashes?
Are you suffering from frail bones? In any of these cases
you would be wise to continue with HRT. If your symptoms are
tolerable, and you are not developing frail bones then you
might want to look at alternatives to HRT. In conclusion,
we could summarise that the media has been guilty of a little
bit of sensationalism by publishing the results of the HRT
trial before it had been properly reviewed. Many other medical
observers are sceptical of the way that the trial was conducted,
claiming that all variables (age for example) were not taken
into consideration. This does tend to leave the people at
the centre of all this, the woman herself, rather confused!
Menopausal or pre-menopausal woman need to look at all options
that are available to them. Try to find a health adviser that
is impartial to both natural and conventional medical therapies;
someone that will recommend what is right for you, and not
just give you what they are comfortable prescribing. We are
blessed in this day and age to have the occasional qualified
medical practitioner that is also versed in the use of natural
therapies. The Internet has a wealth of information for women,
as well as chat rooms, and on-line advice (try www.menopause.org,
or www.menopause-online.com).
Here are a few more specific concerns that have crossed my
desk.
Q. If I want to stop taking HRT should I stop “cold
turkey”?
A. No.You should decrease the dose gradually so as to avoid
withdrawal symptoms.
Q. I am 35 years old and had both ovaries removed due to
cysts. I have been on HRT since the operation. Where do these
latest findings leave me?
A. The women in the latest American study were all over the
age of 60. It would be reasonable to assume that some one
like your self would not be in the same risk category as someone
of 60 years and over. The hormones that have been prescribed
by your doctor are just replacing hormones that would have
been made by your own ovaries anyway. If you had any doubts
I would contact your treating doctor, although I feel sure
that his opinion will not differ.
Q. Is taking a calcium supplement enough to prevent osteoporosis?
A. No. If you are not taking HRT and you are concerned about
osteoporosis, you should take a calcium supplement (1,500
mg daily) with Vitamin D as well as do regular weight bearing,
strength building exercise (30 minutes daily). This could
include walking, swimming, bike riding, light dumbbell work,
Tai Chi etc, etc. Dietary sources of calcium include dairy
products (milk, cheese, yoghurt), sesame seeds, and bony fish
(sardines). Adequate protein in the diet is also essential
for calcium absorption (80gms /day).
Q. How will I know if I am at risk for frail bones or “Osteoporosis”?
A. You won’t. The first sign of osteoporosis unfortunately
is a broken bone. Some one suffering from osteoporosis would
break a bone much easier, and with more severe or multiple
breaks, than someone that is not. Osteoporosis classically
effects the long bones (arm and leg bones) first. Most people
for example, would know of an elderly person that has broken
the long bone in their leg (femur) in a fall. Those who are
fortunate enough to be able to go overseas for medical assessment
can be assessed for osteoporosis on a bone density scan.
Q. Are there any other therapies that I can use to treat
the hot flashes of my menopause?
A. Soy products (soymilk, tahu or tofu, tempe) are said to
help with this condition. Many people believe this to be one
of the reasons that Asian women on a diet high in soy protein
do not suffer to the extent that their Western counterparts
do. Black Cohosh is a herb once used by the Native American
Indians to treat hot flashes. It is now commercially available;
the dose is 40 mg daily. Natural progesterone formulas are
also available, many woman claim to have had good results
from these products.
Q. I am 32 years old taking the combined contraceptive pill,
and as far as I can see it contains the same hormones that
HRT for older women contain. Does this mean that I run the
same risks as woman on HRT?
A. You are correct in your assumption that the ingredients
of the oral contraceptive pill are very similar to that of
HRT. You are probably not in as greater risk as the women
on HRT as you are in a much younger age group. Once again,
this is a risk versus benefit situation. Are you going to
give someone the oral contraceptive, or let them have many
unwanted pregnancies, resulting in perhaps multiple pregnancy
terminations (abortions), or unplanned large families. Both
of which have undesirable effects to consider.
It has been long known however, that taking the contraceptive
pill for prolonged periods may increase the risk for heart
disease later in life. Any one taking the pill for longer
than 10 years may want to look at alternative methods of contraception.
Any one with a strong family history of heart disease, diabetes,
or who is a smoker may also want to consider other forms of
contraception.
So that’s it from my desk for this week, until next
edition, stay happy, stay healthy, and stay young!
Kim Patra is a qualified Registered Nurse / Midwife, and
mother of three, who has been living and working in Bali for
past 15 years. She has assisted many traveller (... and others)
either as a flying medical escort or just a voice on the end
of the phone! Kim is happy to discuss any health concerns
that your may have. Her e-mail contact is info@chcbali.com
