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

Copyright © 2002 Kim Patra