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Hormone Replacement Therapy – To Choose Or No

The debate is still on. Is Hormone Replacement Therapy (HRT), good or bad?

// Till recently HRT was viewed with caution. The treatment, which targets menopausal women by giving them measured doses of female hormones, was said to be a two -edged sword. Its risks such as breast cancer, and heart disease often outweighed its benefits, which were calming of traumatic menopausal symptoms. This was mainly due to a 2002 study conducted for the prestigious Women Health Initiative (WHI), which claimed that HRT has serious risks such as strokes and heart disease. Hence till now, doctors always prescribed HRT with utmost caution; only when needed urgently.

Yet, last week in what one expert called "a dramatic U-turn", a new WHI study suggested that HRT could in fact protect many patients from such conditions, and claimed that the additional risks might apply only to older women.

HRT, this study said, could in fact, boost the health of women in their fifties or within 10 years of the menopause. This announcement has been met with the expected robust debates and arguments.

Says Dr Heather Currie, a Dumfries-based consultant gynecologist with a specialist interest in menopause: "The really important thing is that this study is not a new one and the findings then in 2002 were just the initial results. This further information is for the same study, which has been further analyzed and is therefore more accurate.

"Most experts felt that the main problem with the study was that its participants were not representative of the women who would choose to take HRT. In particular, the study's age range was 50 to 79. There were a lot of women in the study over the age of 60, and they are going to have very different health profiles compared to those in their fifties, who would be the main group of women who would be going for HRT.

"This further information has come from analyzing the data according to age groups, which is extremely important to notice."

Currie adds: “This latest news brings some balance back. We can't go as far as to say that taking HRT is entirely without risk, but we have to get back the confidence of using HRT with younger menopausal women. We have to realize that, in this group of women, the risk of heart disease and strokes is very, very small. The risk of heart disease and strokes exists in the higher age group of women - but these women wouldn't be using HRT commonly.

"A lot of people who are putting up with their menopausal symptoms because of the 2002 results and subsequent guidance can now be reassured that HRT is still the best treatment for them and their symptoms."

Dr John Stevenson, an HRT expert from the Royal Brompton Hospital in London, is a member of the British Menopause Society and it was he who described the updated research as a "dramatic U-turn".

"At the moment there are too many people either not taking or getting HRT from GPs because of unfounded fears," he says supporting the former views.

Currie and Stevenson both agree that, when doctors use HRT, they need to look at the individual woman, their general health, their medical history and their diet and lifestyle. There is no general approach to menopause treatment, and the aim is to individualize treatment further and help each woman come to an informed choice about whether or not she wants to opt for HRT.

Consequentially, what many experts want now is a statement from the regulatory authorities that HRT is safe when used appropriately, so that those who want to use it can do so without undue worry.

"The Medicines and Healthcare Products Regulatory Agency, which is responsible for drug safety, has to go back and look at the subject again and come out with reassuring recommendations in the light of these findings," says Stevenson. "Women and GPs need reassurance about using HRT urgently."

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