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Do the
benefits outweigh the risks? Esther Williams reports Oestrogen and
progesterone are given to patients in certain combinations depending
on their age. For those in pre-menopause, who are still menstruating,
but irregular, oestrogen is given together with progesterone so
that women shed their womb lining once a month. For those who are
well into menopause, say after two years, they are given a different
dose so they don't shed their lining. When the womb has been removed
or if a woman has a hysterectomy and the ovaries are also removed
(surgical menopause), they are given oestrogen alone. "Women
with a strong family history of osteoporosis have to take precautions
by checking their bone mineral density in their 40s and 'fast bone
losers' should consult their doctors regarding the benefit of HRT
versus non-HRT medications to stop the bone loss. This will go a
long way in preventing fractures in old age. Those suffering from
vaginal dryness and recurrent urinary infections have the alternative
of using oestrogen-containing creams under medical supervision.
If it is a case of hot flushes and sweating, HRT may be used short
term to relieve women of extreme symptoms," gynaecologist Dr.
Nalini Prasad says. HRT can also improve physical appearance. With
the increase in the energy level, it can reduce wrinkles and slow
down the aging process. In the west,
many women take oestrogen to improve their sex lives. "For
without it you may have no sex life at all. When oestrogen levels
drop, the vagina reverts to its prepubescent shape - narrower, short,
dryer, less elastic, thin walls that tear easily and are prone to
infection," states a report. There are two kinds of oestrogen
- plant and animal. Hormones can come in the form of capsules, which
are taken orally or in the form of pellets, which are implants that
have to be inserted into the bottom. HRT is also available in the
form of injections, transdermal patches, oestrogen gels, vaginal
creams and rings. The benefits from these, however, are less compared
to hormones administered orally. Some women
on HRT may find that they put on weight while others may develop
pigmentation problems. HRT is expensive.
It costs around Rs. 800 for a month's course. The decision should,
therefore, be left to the individual who should take every effort
to educate herself on the therapy and its effects. Every woman
should discuss with her doctor the rationality and applicability
of HRT, which will differ from person to person. With oestrogen,
there is no doubt of a woman's wellbeing and a better quality of
life, says Professor Harsha Seneviratne. The decision
to take HRT or not will have to be taken by the woman concerned
after discussion with her medical practitioner. Specialists come
into the scene for more complicated issues that have to sorted out
in the beginning if tests show any abnormality. There are a
wide range of preparations available even for those who do not want
to take HRT. Alternative medicine is being developed. Plant oestrogens
and other preparations can to a certain extent counteract the effect
of lack of oestrogen. Prof. Seneviratne's
advice to all is to have better eating habits giving preference
to natural foods. The diet in our country is different from the
west. The recent diet change to fast foods and other bad food habits
has to be reversed. People should get back to their natural diet,
he recommends. When you should
say NO to HRT: "HRT is
contra-indicated in those with cancer, abnormal bleeding, liver
diseases, thrombo-embolism (clotting problem) and migraine head
aches. This calls for all women to be educated on the subject -
to be aware of the risks and benefits of HRT," Dr. Nalini Prasad
says. US & UK
Trials: The majority
of women in the west until quite recently have taken HRT. The trials
in the UK and US talk about convincing evidence against HRT, causing
panic among many women. Ultimately women need to decide. The medical
profession in South Asia has based their opinion on research done
in the west. More study is required to research the incidence in
our women. Clarifying
the situation about the recently abandoned HRT trials in the US
and UK that have caused much concern, Prof. Seneviratne says, "HRT
studies and trials conducted in the US and UK indicate only the
situation in the west. Further, the media has misrepresented facts
pertaining to the study. A factor that we need to consider is that
only one combined preparation (oral) of oestrogen and progestine
were checked. It should be noted here that this is not representative
of the other preparations available nor of the situation in the
east. In addition, the trials indicated a significant reduction
in hip fractures and colon cancers. Although the trials in the US
have now been abandoned, the treatment still continues." Dr. Chandini
Perera, Plastic Surgeon, Burns Unit, National Hospital however advocates
a better lifestyle as an answer to menopause problems. "We live
in a world where everyone wants instant solutions to every problem
- a 20th century attitude. We expect wonder cures from popping a
pill," says Dr. Perera. "But the way we look and feel
depends on our food intake, our lifestyle and health. Rather than
changing nutritional habits, the modern day career woman continues
to work long hours, paying no attention to proper nutrition but
thinks she can compensate that by taking a pill," she continues. To a great
extent physical appearance when you are over 40, depends on a lifestyle
that was adopted from teenage years. Daily exercise and proper nutrition
would result in stronger bones, heart, less cholesterol and good
skin that will survive even when your body clock winds down. Any
pill, therefore, cannot be a substitute for a poor lifestyle. Educated women
have to take responsibility for their health from the time of menstruation
to menopause. Popping pills to look better, is no answer. "All
drugs have side effects. No single drug can work for all women,"
Dr. Perera insists. Patients expect
a quick- fix solution and doctors who can give them are popular.
The 'HRT hype' like other so-called quick solutions has not fixed
it. HRT may have
a few benefits but the risks far outweigh the benefits. Part of
the effect is psychological. The saddest part is that by taking
on HRT, patients are increasingly becoming more dependent on tests
and medical professionals. "Why should we depend on our doctor
for our beauty?" she asks. Human beings have to be responsible
for their own health and be less dependent on the medical profession. What the studies
reveal: The landmark
study conducted by the Women's Health Initiative indicates that
HRT increases the risk of stroke by 41%, heart attacks by 29% and
breast cancer by 26%. In addition, US findings based on the trials
of long term HRT reveal that among 10,000 women taking HRT there
would be eight extra strokes a year, seven extra cases of heart
disease and eight extra breast cancer. Some of the
risks highlighted in the US National Cancer Institute study *Prolonged
exposure of the uterus to oestrogen without progesterone increases
a woman's risk of endometrial cancer (cancer of the uterine lining). * Combined
oestrogen and progestin is associated with an increased risk of
cardiovascular disease. * Combined
oestrogen and progestin therapy increases the risk of invasive breast
cancer. * Oestrogen
use is associated with an increased risk of ovarian cancer. * Women who
use oestrogen plus progestin are at increased risk for blood clots,
gall bladder disease and stroke. Increased cases of blood clots
in the lung and inflammation of veins have also been reported with
hormone use. |
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