Medical Questions & Answers » womens problems

Pros and Cons of Hormone Replacement Therapy

medicalquestions — Fri, 15 Aug 2008 06:00:18 +0000

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.

Can menopause be controlled?

medicalquestions — Wed, 13 Aug 2008 06:00:42 +0000

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.

Hormone Replacement Therapy

medicalquestions — Wed, 13 Aug 2008 06:00:32 +0000

Question: Should all women use hormones after menopause to prevent osteoporosis?
Women should consider their options at the time of the menopause and discuss them with their doctor. Generally, all women should be on hormone replacement therapy (HRT) after the menopause, not only to prevent osteoporosis, but to also prevent heart disease, strokes, premature ageing of the skin, Alzheimer’s disease and generally protect the body from ageing too quickly.
It always necessary to exclude any contra-indications to HRT, such as liver disease or blood clots.
If a woman is small boned and has a family history of osteoporosis, she has an increased risk of osteoporosis, and HRT is even more important.
The main problem most women complain of with HRT is the continuation of their periods beyond the normal time for their cessation. These periods are usually very light though, and often cease with time. Other side effects are usually related to an incorrect hormone dosage. They include headaches, depression, flushes and pelvic discomfort. As all women are different, finding the correct dosage can sometimes be a matter of trial and error.

Question: I have had breast cancer and a total hysterectomy at a relatively early aqe. I am concerned about premature aqeinq but my doctor says I cannot take hormones. What can I do?
This is an extraordinarily difficult problem to deal with. Most women who have a total hysterectomy take oestrogen to prevent the problems of menopause, but if you have had breast cancer, most doctors believe that you should not use this hormone because it may result in a recurrence of the cancer. More recently, some doctors are using oestrogen in this situation as they argue that oestrogen does not cause breast cancer. I would suggest that you avoid oestrogen unless it is absolutely necessary to use it.
To prevent osteoporosis you should eat plenty of dairy products and take calcium tablets. The premature growth of facial hair can be controlled by a medication called spironolactone. Exercise is important to keep your body toned up as much as possible. A well-fitted bra and possibly plastic surgery may help the sagging breasts and can replace a breast removed for cancer. Skin moisturizers and plastic surgery can be used to control premature skin ageing in all parts of the body.
By being careful with your body and taking the appropriate medical advice there is no reason why anyone should place you in an older age group than you are, and you should live a full and normal life well into your 80s.

Contraceptive Pills

medicalquestions — Sat, 07 Jun 2008 06:00:14 +0000

Question: I have not had a period for 5 months after stopping the pill. Is this normal?
About 10% of women who use the contraceptive pill have a delay in the return of their periods after stopping it. It is nothing to be overly concerned about, and can occur just as easily after one month on the pill as after ten years on it. Unless you are very eager to fall pregnant, doctors will wait for about six months before prescribing hormone tablets to start your cycle again. The vast majority of women will restart their periods within six months.
Some women have a tendency to miss periods for emotional, hormonal and other reasons. These women are the ones most likely to develop this problem. The pill has no effect on the long-term fertility of a couple, but is often blamed for difficulty in falling pregnancy because 15% of all couples have a delay of over a year in conceiving.

Question: I have just had an appendix operation. The doctor examined my ovaries during the operation, and he says they are very small. Is this serious?
Some people have small noses, others big noses. Some people have small feet, others big feet. Some people have small ovaries, others big ovaries. The actual size of the ovary has no effect upon your fertility or femininity, unless their size is due to fibrosis or disease. If this was the case, the surgeon would probably have commented about it, and referred you to a gynecologist for a further opinion and treatment.
The ovaries are responsible for producing an egg every month that has the potential to be fertilized and implant in the womb in pregnancy. The ovaries also produce hormones that give you your appearance as a woman. The breasts, for example, develop in the first place and continue their firm shape because of the hormones produced in the ovary. If you are concerned, you should contact the surgeon again and ask him if the small size of your ovaries was due to disease.