Question: I am in my fifties and would like to know the pros and cons of hormone replacement therapy. How should I take them and how safe are they? What do you think of vaginal oestrogen creams?
I personally recommend HRT to all my patients, unless there are specific reasons that they should not take hormones. Generally speaking, HRT has E’en a major advance in the health of women, who now outlive men by an average of more than seven years.
The points for and against hormone replacement therapy (HRT) sre outlined as simply as possible in the following points.
PROS:
• Prevents osteoporosis (thinning of bones) and fracture.
• Slows the development of wrinkles and keeps the skin moist and more elastic.
• Lubricates the vagina and enhances sexual pleasure.
• Slows the sagging of breasts by maintaining breast tissue.
• Relieves the hot flushes, depression, bloating and othei symptoms of menopause.
• Regulates irregular periods to make them milder and less painful.
CONS:
• Menstrual periods may restart, or continue, for a year after HRT
commenced.
• May cause breast tenderness if dosage too high.
• Nausea and belly cramps may occur.
• Migraines may be aggravated.

Except under special circumstances, HRT should not be used in women who have had:
• Cancer of the breast, uterus or cervix.
• Hormonal mastitis (breast pain).
• Endometriosis.
• Blood clots (thromboses), liver disease or strokes.

Question: Why can’t all women who have troubles with the menopause have hormone replacement therapy with oestrogen? Why can’t they stay on treatment until they are 60, 70 or indefinitely?
The vast majority of women can take hormone replacement therapy with both an oestrogen and progestogen to overcome their problems. It is necessary to take both hormones to prevent some of the long-term complications of constant oestrogen use. Women who have had a hysterectomy need only take oestrogen.
There are a small number of women who should not use hormone replacement therapy, including those who have had breast or gynaecological cancer, blood clots or liver disease.
Most GPs are sympathetic to these women, who may suffer flooding, cramps, depression, flushes, headaches, irritability etc. etc. etc.!!!
There are a number of different types of oestrogen, and vaning dosage regimes, and it sometimes takes a little trial and error to get the dosage just right for an individual woman. Oestrogens also protect against osteoporosis, heart disease, and dementia, skin ageing and improve the libido (sex drive) of older women.
There is a great deal of controversy about how long this treatment should continue, but there is no reason why they should not be continued beyond 70 years of age. Oestrogens are not a long term ‘youth pill’, but cm certainly help women through a difficult period in their lives and prevent l lot of the complications of ageing.

Question: I heard recently that women who could not produce hormones naturally, either due to the change of life or after a total hysterectomy should have hormone replacement therapy to prevent osteoporosis. What is your opinion?
Women who have a total hysterectomy (removal of the womb and both ovaries) will age prematurely, and have an increased risk of osteoporosis, particularly if the surgery is performed at an early age. Unfortunately, the most common reason for a total (as opposed to sub-total) hysterectomy is cancer in the area of the ovaries or womb.
Any hormones given to these women in the future may rarely cause a recurrence of their cancer. These women are therefore caught in a cleft stick, and will need to discuss their individual problems carefully with their gynecologist. The treatment will depend on what type of cancer they had, where it was, how advanced it was, and how severe the symptoms caused by the lack of hormones. Fortunately, most women who have a hysterectomy have a sub-total one, where at least one ovary is left behind. These women can be treated the same way as those who have never had any surgery.
Women who are going through the menopause and who are suffering from significant effects of this natural change can be helped by regular hormone supplements. This usually involves taking estrogen either constantly or for three weeks a month, and those who have not had a hysterectomy will need a course of progesterone for ten days or so every month.
If the symptoms of the menopause are not severe, the family history should be checked, and if the patient’s mother or grandmothers suffered from osteoporosis, again hormone supplementation is advisable. If there is no history of osteoporosis, and no significant effects from the menopause, hormone supplementation can still be beneficial by reducing the incidence of strokes and heart attacks, and improving skin tone and appearance.