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: As I get older I am scared about the problems of menopause. My mother had a terrible time and I have no desire to follow in her footsteps. Can the menopause be controlled?
I find the biggest problem with the menopause is the failure of my patients to tell me exactly what they are feeling and what affects the menopause is having on them. The first step in treating someone with menopausal symptoms is explanation.
The sex hormones are controlled by the brain, and are released from the ovaries into the bloodstream on regular signals from the pituitary gland, which sits underneath the centre of the brain. Once in the blood, these hormones have an effect on every part of the body, but more particularly the uterus, vagina, breasts and pubic areas. It is these hormones that make the breasts grow in teenage girls, give you regular periods as their levels change during the month, and cause hair to grow in your groin and armpits. For an unknown reason, once a woman reaches somewhere between the early forties and early fifties, the brain breaks rhythm in sending the messages to the ovaries. The signals become irregular and sometimes too strong, at other times too weak. The ovaries respond by putting out the sex hormones in varying levels, and this causes side effects for the owner of those ovaries. The periods become irregular, vary in length and intensity, and may become painful.
Other symptoms can include bloating and associated headaches and irritability as excess fluid collects in the brain, breasts and pelvis; hot flushes, when hormone surges rush through the bloodstream after excess amounts are released by the ovaries; abdominal cramps caused by spasms of the uterine muscles; and depression which can be a reaction to the changes in the body, a fear of ageing or a direct effect of the hormones on the brain.
Menopause cannot be cured, because it is a natural occurrence, but doctors can relieve most of the symptoms. Hormone tablets or patches are the mainstay of treatment. One hormone is taken for three weeks per month, and a different one is added in for the last 7 to 14 days. Minor symptoms can be controlled individually. Fluid tablets can help bloating and headaches, and other agents can help uterine cramps and heavy bleeding. Depression can be treated with specific medications.