Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) is the daily use of the hormone oestrogen alone (known as oestrogen replacement therapy) or in combination with the synthetic hormone progestin. HRT is taken during menopause to increase levels of oestrogen that usually decrease during menopause.

During menopause, the body makes less of the female hormones oestrogen and progesterone, causing symptoms such as hot flushes, sleep problems, or vaginal dryness. The extent of these symptoms varies between women. Decreased levels of oestrogen also put women at risk of heart disease, stroke and osteoporosis. Most women are prescribed HRT, which combines oestrogen and progestin (a form of progesterone). Women who have had their uterus (and cervix) removed by hysterectomy should use oestrogen alone.

BENEFITS OF HRT:
• HRT relieves hot flushes and vaginal/urinary tract symptoms associated with menopause.
• HRT appears to reduce the risk of fracture in postmenopausal women. However, this is temporary, as once a woman stops taking HRT, bone loss resumes.
• HRT may reduce the risk of bowel cancer.

RISKS OF HRT:
• Results from the Women's Health Initiative Trial of 16,000 postmenopausal women indicate that combined oestrogen and progestin therapy does not have a protective effect on the heart and may increase the risk of heart disease (e.g. non-fatal heart attack, heart attack leading to death, stroke, thrombosis). As a result of these findings, the American Heart Association recommends that women do not start or continue combined HRT (oestrogen and progestin) for the prevention of coronary heart disease.
• There appears to be an increased risk of developing breast cancer in women using combined HRT. This risk appears to increase with the number of years a woman is on combined HRT therapy.
• HRT appears to increase the risk of thrombosis and may not be suitable for women who are at risk of thrombosis (e.g. those who have had a previous thrombotic event or those with genetically inherited thrombophilias). Additionally, during times when the risk of thrombosis increases (e.g. when a leg has been fractured or after surgery), consideration should be made to stopping HRT temporarily.
• A recent clinical trial has revealed that oestrogen plus progestin HRT can increase the risk of dementia in postmenopausal women aged 65 years or older. Oestrogen plus progestin HRT does not prevent mild cognitive impairment in women.

POSSIBLE SIDE EFFECTS OF HRT:
• Bloating, breast tenderness, nausea, weight gain, vaginal discharge, headaches and mood swings.
• Some women who take oestrogen and progestin may have vaginal bleeding a few days every month. If this bleeding bothers you, you can talk to your doctor about adjusting the dose of oestrogen to prevent it.
• Patches may also have the following side effects: redness and itching, sweating and dizziness.

TREATMENT OPTIONS
Your Doctor will inform you of the benefits and risks involved with using HRT. It can be taken in a variety of ways, including tablet or capsule form, skin patches, an implant placed under the surface of the skin or a cream or pessary inserted into the vagina. It is most common for women to be prescribed a combination of oestrogen and progesterone. Your Doctor will discuss the different options with you.
It is recommended that every menopausal woman undergoes an annual examination of her breasts, vagina, cervix, uterus and ovaries. A mammogram (breast X-ray) and pap smear should be performed every 2 years. As each woman is approaching menopause, is it advisable to have a bone mineral analysis performed. This will screen for osteoporosis.

DIET HINTS
• Eat a variety of nutritious foods.
• Eat plenty of wholegrain breads and cereals (preferably wholegrain), vegetables and fruits.
• Eat foods containing calcium to maintain bone strength. These include dairy products such as low fat milk, cheese and yoghurt.
• Drinks containing caffeine can increase calcium loss from bones. Try herbal teas, decaffeinated products or coffee substitutes.
• Maintain a healthy bodyweight by balancing food intake and regular physical activity. Regular weight bearing exercise (walking for example) will also help maintain bone strength.
• Certain foods are thought to have mild oestrogenic activity (called phyto-oestrogens). Regular consumption may alleviate the symptoms of menopause but they are not recommended as an alternative to conventional HRT. Soy products (for example soy milk, soy beans, tofu, and tempeh) are good sources of phyto-oestrogen.
• Eat a diet low in fat and, in particular, low in saturated fat.

VITAMINS/MINERALS/HERBS
Nutritional supplements are only to be used if the dietary vitamin intake is inadequate.
• Calcium has a protective effect on bone density. Calcium supplements with added vitamin D will be absorbed more efficiently by the body.
• Vitamins A, C, E, zinc, grape seed extract and selenium are antioxidants. Studies indicate that menopause may increase the body's requirement for antioxidant nutrients.
• Fish oil capsules are a good source of omega-3 fatty acids. Research indicates that supplementing with fish oil can reduce cardiovascular disease risk factors, in postmenopausal women receiving and not receiving HRT.
• There are a number of herbs that are used as alternatives to HRT. Studies indicate that black cohosh (Cimcifuga racemosa) helps to suppress hot flushes and relieve vaginal dryness. Siberian ginseng (Eleuthrococcus senticosus) is traditionally used to help alleviate mental and physical fatigue associated with menopause. The herbs St. John's wort and oats (Avena sativa) have properties, which may help to reduce anxiety symptoms, which may increase with the onset of menopause. It is strongly advised that you consult your Doctor before taking any herbs in conjunction with HRT.
• Some other herbal medicines may interfere with Hormone Replacement Therapy, including Dong Quai, Panax Ginseng, Black Cohosh and Red Clover. Ask your health care professional for advice.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints.
2. It is very important to take medication correctly. Check with your Pharmacist and check for possible drug interactions.
3. A regular exercise programme, such as swimming and walking, can help maintain bone strength, cardiovascular fitness and a healthy bodyweight. Specific Pelvic Floor Muscle Exercises will help maintain the health of the urinary and reproductive system.
4. Fifteen minutes of sunlight a day will ensure adequate Vitamin D is produced to maintain bone strength.