10 reasons for Hormone Replacement Therapy (HRT) Clinic

10 reasons for Hormone Replacement Therapy (HRT) Clinic

August 15, 2011
(1). HRT will stop your hot flushes and sweats

Troublesome hot flushes, severe night sweats and headaches causingchronic insomnia are characteristic symptoms of the menopause.These symptoms may last for many years. Apart from being sociallyembarrassing they result in tiredness and depression becauseof lack of sleep. These symptoms can almost invariably be curedwith the correct small dose of estrogen. Although selectiveserotonin reuptake inhibitor antidepressants have been suggestedfor the treatment of vasomotor symptoms, no other treatmentis nearly as effective as estrogens. Women who still have auterus should still have 7–12 days of progestogen in orderto produce a withdrawal bleed and prevent endometrial hyperplasia.

(2). Estrogens will treat vaginal dryness and many causes of painful intercourse and lack of libido

Thinning of the pelvic tissues producing vaginal dryness andoccasionally bleeding is another characteristic result of estrogendeficiency that occurs after the menopause. This also can besuccessfully treated with estrogen either by tablets or throughthe skin by patches or gels or implants. Transdermal estrogentherapy is probably the safest and most effective route as hepaticcoagulation factors are not stimulated. Local estrogens canalso be given for this symptom using local vaginal applicationsof weak estrogens such as oestriol that are hardly absorbed.Other related problems of painful intercourse, loss of libidoand recurrent ‘cystitis’, if due to pelvic atrophyare also effectively treated by systemic or long-term localvaginal estrogens.

(3). HRT increases bone density and prevents osteoporotic fractures

Every study confirms that estrogens are the most effective wayof increasing bone density and preventing osteoporotic fractureseven in low-risk women. This treatment is very safe when startedin women under the age of 60. It is more effective and beneficialthan the bisphosphonates that are frequently used by bone physiciansas first choice and by general practitioners unsure about thesafety of estrogen therapy. These non-hormonal drugs with theirconsiderable long-term complications should have no place inmaintaining bone density in women under the age of 60. For therecently menopausal women receiving estrogen therapy for climactericsymptoms such as flushes, sweats or vaginal dryness, there willbe a considerable increase, up to 15% in 10 years to such anextent that osteoporotic fractures 20 years later in the olderwomen are much less likely to occur. If these women have lowbone density, even without typical menopausal symptoms, estrogensmust be seen as first-choice therapy. For those younger womenwith severe osteopenia or osteoporosis due to premature menopause,early hysterectomy and oophorectomy or anorexia with amenorrhoea,estrogens are an essential long-term treatment.

(4). HRT protects the intervertebral discs

Important recent studies from several centres have shown conclusivelythat estrogens prevent collagen being lost from the intervertebraldiscs, thus maintaining their strength and function. These discsmake up one-quarter of the length of the spinal column and actas cushions preventing crush fractures of the vertebral bodies.It is these crush fractures that lead to loss of height andthe lordosis of the upper spine known as the Dowager’s hump.This important protective effect of estrogens seems to be uniqueas bisphosphonates and the other non-hormonal treatments oflow bone density do not have any beneficial effect upon thediscs. {As pointed out elsewhere bisphosphonates increase bone density by going to the bond long-term, but done make the bones more resistant to fractures–jk}.

(5). HRT does reduce the number of heart attacks

There are about 30 years of evidence from many observationaltrials that estrogens reduce the incidence of coronary heartdisease. This has subsequently been questioned by the 2002 WHIStudy, which showed an increase in heart attacks. However, thisstudy looked at patients of the wrong age and who were usingthe wrong dose of estrogen and progestogen. Subsequent reportsfrom the same investigators have shown a very much reduced incidenceof heart attacks in women who start HRT below the age of 60.This is particularly apparent in women who have had a hysterectomyand can have estrogens without progestogen. The view now isthat HRT, particularly estrogen alone, is very safe and is associatedwith a reduced number of heart attacks if started below theage of 60. Thus there is primary prevention of coronary heartdisease, but there is no evidence of protection in women withestablished coronary damage.

It would appear that the factor that is associated with theapparent increase in severe side-effects such as breast cancerand heart attacks and possibly stroke is the progestogen componentof HRT. As progestogen also produces unwanted PMS-type side-effectsof depression, anxiety, bloating and loss of libido in patientswho are progestogen intolerant, it is sensible to keep the doseof oral gestogen to a minimum. The alternative is to inserta Mirena intrauterine system, which produces amenorrhoea andavoids the use of oral progestogen with its side-effects forfive years or more.

(6). Estrogens help depression in many women

Estrogens are more effective in the treatment of depressionin premenopausal or perimenopausal women than post- menopausalwomen. However there is no doubt that depression is helped inpostmenopausal women who have been suffering from night sweats,insomnia or vaginal dryness, painful intercourse and maritalproblems in that most of these problems can be effectively treatedand removed. However, it is true that the most impressive effecton mood is seen in younger perimenopausal women in the 2–3years before the period cease in the menopausal transition.This cannot be diagnosed by blood tests but by a careful history.This depression often occurs in women who are sensitive to abruptchanges in their hormones, either endogenous oestradiol or progesterone.These women had previously had postnatal depression and premenstrualdepression in what should be known as reproductive depression.They often also have cyclical headaches/migraines that occurwith the cyclical hormonal fluctuations at menstruation. Aspremenstrual depression becomes worse with age, it blends intothe more severe depression of the transition phase and is veryeffectively treated by moderately high-dose transdermal estrogensused by patches, gels or implants.

(7). HRT improves libido

HRT certainly improves libido if estrogens are used to curevaginal dryness and painful intercourse. Even without thesecharacteristic symptoms, estrogens can improve sexual desire.However, if necessary, the addition of testosterone has a moredramatic effect upon libido, frequency of intercourse and intensityof orgasm. Testosterone patches licensed in women after hysterectomyand testosterone gels in the appropriate dose are often andshould be used ‘off license’ with full consent andexplanation.

Women must be aware that testosterone is not only a male hormonebut it is an essential female hormone present in women in about10 times the blood levels as estrogen. It is an essential hormone,important for energy, mood and sexuality.

(8). HRT improves the texture of the skin

After the menopause, women lose about 25% of their body collagen,which is manifested by thin inelastic skin, brittle nails, lossof hair and loss of the collagenous bone matrix. This latterloss is an essential cause of osteoporosis and osteoporoticfractures. Estrogen therapy replaces the lost collagen in theskin and the bone. Its affect on the facial skin is a very obvioususeful cosmetic effect.

(9). ‘I am a nicer person to live with’

This is a quote from a patient. Many women say that when estrogentherapy stops their depression, their loss of libido and theirirritability, they become more agreeable people for their partnersto live with. The depression, irritability, grumpiness and lossof energy and disinterest in sex can usually be improved considerablyby the appropriate doses of the appropriate hormones that mayinclude testosterone as well as estrogen.

(10). HRT is safe

In spite of the press reports stressing bad news, virtuallyall claims of major adverse effects from the WHI study havebeen reconsidered even by the investigators. It seems quiteclear that the reported major side-effects of breast cancer,stroke and heart attacks occurred in women who started the wrongdose of HRT over the age of 60. In women who started below theage of 60 there were fewer heart attacks, fewer deaths, fewerosteoporotic fractures and even less breast cancer in this study.It is probable that the one residual side-effect is a small1% extra lifetime risk of developing breast cancer, but thisis no more than the breast cancer risk of being overweight,drinking wine, having no children or even taking statins. {DISAGREE: As above stated the author