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Hrt: disadvantages and contraindications HRT: DISADVANTAGES AND CONTRAINDICATIONS
‘Few therapies in the medical field have generated such controversy as that of hormone replacement.’ from Medical Clinics of North America, 1987.
One day, possibly, medicine will come up with a treatment that is 100 per cent effective, 100 per cent safe, and totally without side-effects in anybody. But don't hold your breath!
Hormone replacement has many advantages, particularly in improving the quality of life for women at, or beyond, the menopause. With the exception of heart attack or stroke, the symptoms of low oestrogen are not life-threatening; women are not going to die from hot flushes, tiredness, loss of continence, or even directly from osteoporosis. But all these things greatly reduce their self-image, self-esteem and general enjoyment of life. So any treatment that can improve these conditions would seem to be well worth considering.
HRT, like every treatment for every condition currently available on the traditional medical market, has its drawbacks. But it's the best we've got at the moment, and millions of women derive great benefit from it: their hot flushes disappear, sex becomes enjoyable again, and their chance of getting osteoporosis or heart disease is greatly reduced. Many also notice an improvement in the quality of their skin and hair, in reduced muscle and joint pains, in increased energy and vitality and in their sense of well-being.
Why, then, are only 9 per cent of menopausal and postmenopausal women in the UK taking HRT at any one time, and why do most give up after just a few months?
‘I felt quite bloated, and had headaches and breast tenderness.’
‘After three months I just couldn't cope with having periods again.’
‘HRT certainly helped my hot flushes, but I gave up after putting on weight.’
‘It made me feel irritable and depressed.’
‘I am afraid of breast cancer.’
‘The patch made my skin red and itchy, so I changed to tablets, but they caused heart palpitations.’
‘Fluid retention and leg cramps made me feel really uncomfortable.’
‘My doctor doesn't believe in it. 9 CI just don't think it's natural.’
The main reasons why women don't even start taking HRT are the feeling that it is 'going against nature', together with a lack of knowledge of how it works and why replacing oestrogen after the menopause can be such a good thing.
‘I think HRT is interfering with nature, and I can't imagine that I would ever want to use it. It seems all wrong to me.’
The two commonest reasons why women who are already on HRT give it up are a dislike of monthly bleeds, especially among those well past the menopause, and the fear of breast cancer, which is shared by doctors and patients alike. Other real turn-offs are the need to take a pill every day (or change a patch every few days), the cost of prescriptions for the under-sixties, a slight weight gain and nausea, a return to pre-menstrual tension (if you take progestogen), and the need for regular gynaecological checkups. This chapter looks at these, and also at who may be advised not to take it at all for medical reasons.
In addition to those who give up HRT for all the above reasons, there are those who do so because it doesn't relieve their symptoms. Unfortunately, most women who give up because of side-effects have only ever tried one form of HRT. But as you will realise by now, if you get either no relief, or undesirable side-effects, the many combinations of oestrogen and progestogen on the market should mean that you can eventually find one that is right for you. If you are to find the right one, you may have to persevere for several months, trying out different preparations, and this will obviously mean several return visits to the doctor. A survey of women conducted in 1992 by The Amarant Trust found that women who had received only brief and inadequate information on HRT when they were first prescribed it, were very much more likely to give up after only a few months than women whose doctors had taken the time and trouble to explain about the menopause, about how HRT works, and to give them a realistic idea of possible side-effects. Don't be afraid of being thought a member of The Awkward Squad: it's your body, and oestrogen replacement could make all the difference to your present well-being and future health.
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