Considering HRT? Read This…

I read this Medscape report which is a review of menopausal treatment and thought it was a really useful sort-of checklist for women considering taking HRT, so copy it for you below. Note this is a review of non-natural approaches and it gives a view of what orthodox treatment might help and which won’t or might be too risky. Remember, we can discuss natural approaches, and use supplements like DIM to offset oestrogen dominance if you have to use HRT. Just ask me. 

“April 8, 2010 — Women must be informed of the potential benefits and risks of all treatment options for menopausal symptoms and concerns and should receive individualized care, according to a review of the role of perimenopausal hormone therapy published in the April issue of Obstetrics & Gynecology.

Study Highlights

  • Health concerns during menopause include vasomotor symptoms, including hot flushes and night sweats; urogenital atrophy; osteoporosis; and depression and disordered mood.
  • Vasomotor symptoms:
    • Associated factors are African American ethnicity, high body mass index, smoking, low physical activity, and surgical menopause.
    • The most effective treatment is systemic estrogen therapy.
    • Progestin alone and combined estrogen-progestin therapy are also effective.
    • Alternative treatments are lifestyle changes (cooling body temperature, weight loss, smoking cessation, relaxation, and acupuncture) and prescription medications not yet approved by the Food and Drug Administration (clonidine, paroxetine, venlafaxine, and gabapentin).
    • Nonprescription medications have not been proven to be more effective than placebo.
  • Urogenital atrophy:
    • The recommended treatment is low-dose vaginal estrogen.
    • Long-term treatment effects are unknown.
    • Alternative treatment is a vaginal moisturizer.
    • Incontinence is increased by systemic estrogen therapy and combined estrogen-progestin therapy, but urinary frequency, urgency, and recurrent urinary tract infection are decreased with vaginal estrogen therapy.
  • Osteoporosis:
    • Risk factors are age, Asian or white race, family history, history of fracture, early menopause, prior oophorectomy, low body weight, low calcium and vitamin D intake, smoking, sedentary lifestyle, anovulatory conditions, hyperthyroidism, hyperparathyroidism, chronic renal disease, and systemic corticosteroid use.
    • Hormone therapy with low-dose estrogen or estrogen/progestin therapy increases bone mineral density and decreases fracture risk during treatment but is not recommended solely for osteoporosis.
    • Alternative treatments include bisphosphonates, raloxifene, parathyroid hormone, calcitonin, and alteration of modifiable risk factors.
  • Depression and disordered mood:
    • Hormone therapy for vasomotor symptoms might improve sleep disruption and mood, but the primary treatments are antidepressant medications, psychotherapy, and counseling.
  • Contraindications of hormone therapy use include cardiovascular disease, breast or endometrial cancer, and impaired cognitive function.
  • Cardiovascular disease:
    • Risk factors are age, family history, smoking, obesity, sedentary lifestyle, diabetes, hypertension, and hypercholesterolemia. Combined estrogen-progestin therapy has increased the risk for coronary heart disease.
    • Estrogen therapy in women without a uterus was linked with an increased risk for stroke and venous thromboembolic events and disorders, but not coronary heart disease.
    • Alternative treatments include alteration of modifiable risk factors and treatment of associated conditions.
  • Breast cancer:
    • More than 5 years of combined estrogen-progestin therapy was linked with increased breast cancer risk.
    • Hormone therapy should not be used in women with a history of breast cancer and should be used with caution in women at high risk for breast cancer.
    • Alternatives for women at high risk for breast cancer are tamoxifen or raloxifene, screening mammography, and self-breast examination.
  • Endometrial cancer:
    • Hormone therapy is generally contraindicated but can be considered in highly symptomatic women with a history of early-stage endometrial cancer.
  • Cognitive function:
    • Hormone therapy was associated with a 2-fold increased risk for dementia, most commonly Alzheimer’s disease, adverse cognitive effects, and lower scores on the Modified Mini-Mental State Examination.
  • Other contraindications to hormone therapy include active hepatic and gallbladder disease.
  • Regarding ovarian cancer, hormone therapy was linked with no effect, but a small increased risk was observed. Limited data showed that hormone therapy does not appear to affect survival duration in survivors of ovarian cancer.
  • Regarding colorectal cancer, combined estrogen-progestin therapy was linked with a reduced risk, but estrogen in women with a history of hysterectomy had no effect. Hormone therapy is not recommended for prevention of colorectal cancer because of risks of treatment and effectiveness of screening methods.

Clinical Implications

  • Hormone therapy is primarily indicated for healthy menopausal women with vasomotor symptoms, and local estrogen therapy is recommended if only vaginal symptoms are present.
  • The contraindications to hormone therapy in menopausal women are breast or endometrial cancer, cardiovascular disease, thromboembolic disorders, and active liver or gallbladder disease.” Medscape, April 10.

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