ALL CHANGE – A NUANCED MESSAGE ABOUT HRT

First it was good for you, then bad for you but now the message is different.
I remember a time when HRT was promoted as the best thing since sliced bread. Every woman should have it, even those without significant menopausal symptoms – it would prevent heart disease and help women stay young and healthy. If you didn’t take it you would dry up and crumble away. I was wary of it because my mother who had been on oestrogen only HRT for a long time and loved it, was diagnosed with ovarian cancer in the early 1990s and shortly afterwards died when she was in her early 70s. I wondered about possible side effects and discovered a small study which suggested an increased risk of developing the cancer for women who had been on oestrogen only HRT for more than 5 years.
Then two big studies came along in 2000 and 2002 calling into question HRT’s safety. Women taking it were reported for example to be at increased risk of strokes, clots and breast cancer and HRT did not protect against heart disease. Consequently women stopped asking about HRT and many doctors stopped prescribing it.
But numerous studies since have concluded that HRT when taken in the early years after the menopause and at the right dose is safe for most women says Kathy Abernethy, nurse expert in the menopause.
The first ever NICE clinical guideline on the menopause is due out in 2015 making it imperative that healthcare professionals get up to speed about this she says. The message about HRT now is that it’s for women who suffer significant menopausal problems and it should be started for the first time within 10 years of the menopause. Taken at the lowest effective dose, the risks are much fewer and HRT does not cause heart disease and may indeed be protective. Most women come off HRT by the time they’re 60 because their hormones have stabilised says Kathy. But HRT may be more risky if you want to take it for the first time ten or more years after your menopause. In the intervening years fatty deposits may have built up in your arteries increasing the risk of cardiovascular problems so you need to be carefully assessed to see whether you can safely take HRT.
Good menopausal care means holistic personalised advice about the conventional and alternative options open to women, the importance of lifestyle advice and the need to respect women’s choices stresses Kathy. This is all to the good because in my mother’s case all those years ago she wasn’t offered any other options – whenever she tried coming off HRT her horrible symptoms returned with a vengeance so she went back on HRT – for far too long. For my own part I think the watchword that still comes to mind when thinking about HRT is caution.
See my piece ‘HRT is just right for some women’ Nursing Standard 10th September 2014,
http://rcnpublishing.com/doi/abs/10.7748/ns.29.2.25.s28

Advertisements