HRT – the Devil and the Deep Blue Sea

Whether through a surgical or pharmaceutical intervention, or the march of mother time, menopause is a life stage that can present many challenges for women. And the apparent choice women are so often are presented with at menopause is to take HRT or suffer.

HRT – What You Need to Know Before You Decide

Menopause – a time of upheaval

Menopause can bring its challenges. It may be the intensity of the symptoms: hot flushes and night sweats, hormonally induced mood swings, poor memory and conchrt menopause womanentration, joint pains, changes in libido, disturbances in sleep and the ensuing fatigue or the many other symptoms that can crop up at this life stage. Emotionally it can be a difficult time, the ups and downs of our hormones affecting us on every level. And this can all arrive at a time when there are other pressures at home and work.

It may be a time of massive upheaval – within our bodies, how we feel about ourselves, our relationships and role in the world. No wonder women can find themselves sitting in front of their GP desperate for some kind of support. But what will be on offer: HRT (hormonal replacement therapy), or perhaps sleeping pills or Prozac?

And then women may find themselves between the proverbial rock and a hard place. One of the phrases I have heard most over the years is “I wish I had known about all this years ago” – the risks, and the range of options.

What are the Potential Risks for HRT?

Even a cursory glimpse of HRT’s profile will reveal that there are risks, but how significant are they? When a major cancer charity, such as Cancer Research UK cited cutting prolonged HRT use as a way of reducing the risk of breast cancer [1], it became even clearer that any benefits HRT may bring could come with a price tag none of us ever want to have to pay.

This advice came on the back of a series of studies that shone the spotlight on the hazards of taking HRT, leaving many women wondering whether the alleviation of symptoms was outweighed by the potential health risks.

drugs smarties 2In the United States, the Women’s Health Initiative research programme was stopped early in 2002 when the results showed an increased likelihood of heart disease, blood clots, stroke and breast cancer [2] [3]. In 2007 the Lancet published results from the Million Women Study [4]. This and their previous research have shown that taking HRT can increase a woman’s risk of breast, ovarian and womb cancer.

October 2012 saw a Danish study, published in the BMJ ((British Medical Journal), which triumphantly announced that HRT taken for 10 years significantly reduces the risk of heart failure and heart attack. They also concluded that it did so “without any apparent increase of cancer, venous thromboembolisms (DVT) or stroke…however, they stress that due to the potential time lag longer time may be necessary to take more definite conclusions” [5].

The response from Cancer Research UK was cautious: “This is a small study that wasn’t specifically designed to look at whether using HRT was linked to cancer risk. This, along with other concerns about how the study was conducted, means we cannot be confident about what it says on the subject of breast cancer risk and HRT” – Dr Claire Knight ” [6].

This Danish study came after other larger studies that showed there to be both cancer and cardio-vascular risks when taking HRT. In the light of the 2002 WHI study, prescribing guidelines for HRT changed, and doctors and their patients were encouraged to consider HRT as a short term measure where symptoms were severe. However, there are women who either do not wish to take or continue with HRT, or who are unable to because of their medical history.

More recently University of Oxford research published in the Lancet showed that an analysis of 52 separate studies found an extra case of ovarian cancer for every 1,000 women taking HRT for 5 years from the age of 50 – February 2015 [7]. In March 2015 the British Medical Journal published an analysis by the Cochrane Collaboration which found that HRT increases the risk of blood clots and possibly stroke [8] [9].

HRT: Weighing Up Risks & Benefits

There are many trials and studies that raise significant concerns, and yet women are often told that the benefits outweigh the risks. That the numbers of women who will experience these life threatening side effects are small.

But are these risks really worth taking? How can you or your doctor really know whether you will be in the minority of women who wind up paying a very heavy price? Even if a woman feels well whilst she is taking HRT, she does not know if she will have serious side-effects later as a result.

close-up-court-courthouse-534204As new formulations of HRT, whether standard or Bio-identical HRT are brought to market with promises of improved efficacy and safety, or potentially protective effects, for me, very definitely, the jury is still out.

Many claims were made for “standard HRT” and years on, opinion is still divided about both the benefits and the risks. This is a never-ending debate – there is too much at stake. There will be disagreement about the validity of results of previous and future trials. Whatever new studies do or do not show, however robust they are or are not, or the new forms in which HRT is presented, there is still the inescapable truth of what is being prescribed – sex hormones are powerful steroids that have long-established effects and side-effects.

Perhaps time is the best test, and the most revealing. How many more studies do we need to re-confirm the risks? Will new claims or reassurances for standard or new forms of HRT stand up to the test of time? The debate will continue. There will be times when HRT seems to come in from the cold, then concerns will be raised again because the risks are still there. Meanwhile, you do have choices.

Choices at Menopause

Processed with VSCO with 4 presetDeciding to move beyond the devil and the deep blue sea can be liberating, especially at menopause. But what are your options? The good news is that there are a great many ways in which women can find support taking a more natural approach at menopause.

I have been offering women information and support at menopause for over 15 years. If you visit my website page on menopause you can find out more about how I work. You can also access a great deal of information by reading my menopause blogs.

I hope you have found this blog HRT – the Devil and the Deep Blue Sea to be helpful. If you are interested in receiving more information and updates about upcoming Workshops, you can sign up to the Chantry Health Newsletter.

I see patients in Lewes in East Sussex, in West Sussex, and also via Skype. Please do Contact Me if you would like to arrange a free mini-appointment to see if my approach might suit you.

References:

[1] BBC News Website, “Action Call on Cancer Lifestyle”, 30.9.07
[2] The Journal of the American Medical Association, Vol. 299 No.9, March 5, 2008
[3] Women’s Health Initiative Participant Website
[4] The Lancet, Vol. 369, Issue 9574, 19 May 2007
[5] British Medical Journal Website – press release, 10.10.12
[6] Dr Claire Knight from Cancer Research UK, BBC News Website – 19886932, 10.10.12
[7] BBC News Website, “HRT increases ovarian cancer risk” 13.02.15
[8] British Medical Journal  – BMJ 2015; 350 doi: “HRT increases risk of blood clots and stroke, finds new analysis” (Published 10 March 2015) Cite this as: BMJ 2015;350:h1336
[9] BBC News Website,  “HRT linked to clots – and possibly stroke – study finds” 10.03.2015