Hormone Replacement Therapy (HRT)

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.

DESCRIPTION

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.

As a result of the recent findings from the Women’s Health
Initiative Trial, the Australian Medical Association recommends
that women who do not have menopausal symptoms such as hot flushes
and night sweats should not be taking hormone replacement
therapy.

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

See the HRT Diet topic on the Healthpoint.

• 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.
• Vitex agnus castus (chaste tree) should NOT be taken with
  hormone replacement therapy.
• 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 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.
5. Some non-drug alternatives are available such as Promensil,
   Femone and Menopace. These may help reduce the symptoms of
   menopause. Ask your Pharmacist for more advice.