WHAT IS HRT AND WHAT DOES IT DO?
HRT does the work of oestrogen, levels of which plummet after the menopause. Women usually take a combination of synthetic oestrogen and a second hormone, progesterone.
‘Most women in the UK take combined HRT because taking oestrogen on its own can increase the risk of developing cancer of the womb,’ says Kathy Abernethy, chair of the British Menopause Society. ‘Oestrogen-only HRT is usually only given to women who have had their wombs removed.’
ARE THERE ANY RISKS TO CONSIDER?
A major U.S. study in 2002, from the Women’s Health Initiative USA, was the first to ring alarm bells that HRT may lead to an raised risk of heart disease and breast cancer. As a result, many doctors stopped prescribing it overnight.
But the study was found to be flawed — the average age of the women in the study was 63, when the risk of breast cancer naturally rises anyway, and half were smokers.
‘The risks were overestimated for women of normal menopausal age between 50 and 60,’ says Kathy. ‘For most women under the age of 60, and for many over age 60, the benefits of HRT are clear.’
SO DOES HRT REALLY CAUSE CANCER?
Any risk comes with longer use, says Kathy.
Cancer Research UK says there is strong evidence HRT can cause breast, womb and ovarian cancer, but the chance is low compared to other risk factors. To put it in perspective, while minimising HRT could prevent 1,400 cancer deaths per year, keeping to a healthy weight could prevent 13,200 and stopping smoking could prevent 22,000.
ARE THERE OTHER SIDE-EFFECTS?
‘Women who take HRT may have side-effects including breast tenderness, headaches, nausea, indigestion, tummy pain and vaginal bleeding,’ says Professor Kamila Hawthorne, Royal College of GPs’ professional development vice-chair. Taking HRT as tablets (not patches or gels) may slightly raise the risk of blood clots.
WHO SHOULD NOT BE GIVEN HRT?
Those who have a personal or family history of hormone-sensitive cancers, such as ovarian and breast, and women who have had deep vein thrombosis. High blood pressure should be controlled before starting HRT.
WHAT ARE THE ALTERNATIVES?
Non-hormonal options include Tibolone (Livial), derived from the Mexican yam, which mimics oestrogen. Blood pressure medication Clonidine, which affects the dilation of blood vessels, can alleviate hot flushes and night sweats.
Bio-identical hormones, derived from plant oestrogens and prescribed by private clinics, are said to be similar to human sex hormones. But the NHS does not recommend these as they are not regulated.