FAQ - H. R. T.

H. R. T.

H. R.T. is a way of treating menopausal symptoms & problems.

H. R. T. means Hormone Replacement Therapy. To know about HRT we need to know about Menopause. Menopause is a stage in a woman’s life where after the childbearing is over, the ovaries reduce their output and finally shut down their function resulting in stoppage of menstrual cycles. The ovaries are the organ positioned near the womb. They produce ova or eggs, required to make a baby. They also produce Estrogen + Progesterone which maintain various functions in a woman’s body, especially her reproductive function. The cyclical changes in levels of the hormones estrogen + progesterone cause the regular and orderly occurrence of menstrual cycle. When ovaries are shutting down their function, various symptoms due to lack of these hormones arise.

In brief, following symptoms are seen in some women but not in all women : changes in menstrual cycle, hot flushes, vaginal dryness, vaginal irritation, painful intercourse, repeated urinary infections, urinary incontinence, mood changes, irritability, lack of sleep, lack of concentration, temporary forgetfulness, poor libido or desire for sex, loss of scalp hair, wrinkling of skin, joint pains, bony pain. Also added to above list are symptoms due to diabetes or high blood pressure or heart disease and osteoporosis which may appear a few years after menopause.

 How H.R.T. is useful in above problems ? Menopause is not a disease. It is agreed that symptoms and problems of menopause are due to low levels of the hormone Estrogen. So it was deemed logical to provide Estrogen from outside to make the situation better. Unfortunately the question is not solved so simply. We have to understand that menopause is not like insulin dependant diabetes. In that situation not giving insulin will cause rapid loss of health & possibly death in the diabetic. In menopause lack of estrogen does not cause rapid loss of health &. inevitable death of the woman. What H. R. T. may claim to do is to give estrogen & progesterone over a period of time to reduce symptoms of menopause. In long term use it was claimed that H. R.T. users may benefit by reduced occurrence of heart ailments and fractures of bones.

Please explain again whether HRT is useful or not in menopausal women. Yes, it is important to explain again that H. R. T. means giving hormones to reduce symptoms and prevent major health problems in menopausal women. The short term symptoms of menopause are relieved by giving estrogen for example hot flushes, dry vagina, some urinary symptoms do improve. But this improvement usually lasts as long as you take the prescribed medication under supervision. About long term benefits of preventing heart attacks, brain problems like stroke and vulnerability to fractures at hip, spine etc there is some controversy. The controversy is mainly regarding two aspects of H. R. T. One is, it is not proven beyond doubt by scientifically carried out tests that these serious events are indeed prevented in significant manner. Secondly cost in terms of money as well as increased risk of cancers of inner lining of uterus and breasts. These two cancers are said to be linked to prolonged use of estrogen in post menopausal women. The inner lining of uterus, also called as endometrium is protected by addition of progesterone to the staple hormone estrogen in H.R. T. But the problem of rising chance of breast cancer after five years of HRT use is not acceptable to many women. It is noted that HRT users under medical supervision benefit by screening tests which catch these problems early & escape the worst outcome but all the same this point needs lot of explaining on part of physician taking care of the menopausal woman.

 Which women cannot take HRT ? All women who consider HRT as an option in their menopausal years should undergo counselling regarding the therapy (HRT) as well as some screening tests before starting HRT. To mention in brief the woman needs to undergo Physical and Gynaecological checkup, Pap smear of the mouth of the uterus, breast examination by way of mammography, ultrasonography to look at the endometrium, uterus and ovaries, blood tests to detect diabetes and raised cholesterol levels. There can be more tests depending on the situation. So in short we may avoid HRT in following conditions 1) Cancer of Breast 2) Endometrial cancer 3) undiagnosed abnormal bleeding from vagina 4) Current severe liver ailments 5) Endometroid cancer of ovaries 6) any propensity to form blood clots in leg veins with embolisation to chest. Besides these, we should be cautious in endometriosis, fibroid uterus, thickened endometrium, gall stones, liver diseases etc. In Indian scenario, women who will not come for follow up are not good candidates for HRT because HRT needs strict medical supervision.

Besides higher risk for cancers in long term users of HRT, what are other problems associated with it ? In first few months of starting HRT there is higher chance of getting blood clots in some women. Also there are some side effects like weight gain, premenstrual tension like symptoms and chiefly re-occurrence of vaginal bleeding in those who had stopped menstruating. Without proper explanation & physician support majority of women stop HRT in this situation.

So, what are the alternatives to HRT ? In those women where HRT cannot be given, also in those who do not want it, we may consider some positive health interventions. One is to prepare for menopause from college days by way of good diet and exercise so that you enter menopause in a fit state of mind & body. Other is to adopt life style changes which include diet changes, exercises and achieving peace of mind.

Can one be more specific ? Briefly avoidance of obesity, diabetes, hypertension through diet and exercise helps. Calcium supplements, plant estrogens like soyabean, linseed help. Avoiding being lonely & isolated help immensely. Developing positive outlook for menopausal years is essential. Newer medications with less side effects and better safety profile are awaited, till then one may choose judiciously from existing drugs and alternatives to drugs.

 

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