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: If you have a hysterectomy, do you still go through menopause?
In a hysterectomy, it is normal to remove the cervix, uterus (womb), both Fallopian tubes and sometimes one of the two ovaries. The remaining ovary will produce sufficient hormone, in most cases, to maintain the woman’s normal sexual functions and prevent the menopause.
In due course, this remaining ovary will cease its production of female hormone, and the woman will develop the hot flushes, depression, irritability and headaches characteristic of the menopause. Because her uterus has been removed, she will not suffer from the heavy and irregular bleeding or the uterine cramps that can also occur with menopause. If during the hysterectomy it is necessary to remove both ovaries because of disease, the woman will lose her female hormones instantly and go through a premature menopause. It is important for these women to take hormone supplements until they are in their early sixties to prevent premature ageing, bone weakness, facial hair, sagging breasts and the other unpleasant effects of the menopause.
Women who have had cancer of the ovaries that has resulted in both ovaries being removed may not be able to use hormone replacement, but should carefully discuss this option with their gynecologist.

Question: I am 62 and on treatment for blood pressure. I am concerned about osteoporosis and heart disease and I am considering using the oestrogen patch. I finished my menopause 9 years ago. Are hormones going to help me now? What effect will it have on blood pressure?
Hormone replacement therapy (HRT) using oestrogen and progestogen is very beneficial to women during and after the menopause. If you have had your uterus removed in a hysterectomy, only the oestrogen hormone is required.
These female sex hormones not only relieve the symptoms of the menopause such as hot flushes, irritability, irregular bleeding, breast tenderness etc., but protect women against osteoporosis (weakening of the bones), hardening of the arteries and heart disease. It is a treatment that I highly commend to all women, and may be taken until you are well into your seventies. There is absolutely no evidence that it will cause any increase in the incidence of breast cancer.
Your blood pressure may actually improve using HRT, but there is no guarantee of this. It will certainly not get worse or interact with your medication. Both oestrogen and progestogen can be taken as a tablet, a stick-on patch that is replaced twice a week, or as an implant every three months. Oestrogen is also available as a vaginal cream that is used once or twice a week.
I strongly suggest that after further discussion with your general practitioner you commence hormone replacement therapy.