Background:

At one time, in the 1990s, Hormone Replacement Therapy (HRT) was a standard treatment prescribed for women’s severe menopausal symptoms of hot flashes, night sweats, headaches, incontinence and others. The treatment improved quality of life of the women over several years between the pre-menopause and post-menopause phases.

But ten years ago in 2002, the first Women’s Health initiative (WHI) Report of the National Institute of Health came up with the finding that HRT might increase the incidence of breast cancer, heart disease and stroke among the patients and this led to a dramatic decline in HRT users.

But now things have changed. The conclusions of the WHI study were first questioned when the women under the WHI study were found to be well past their menopause, obese and smokers, thereby already at risk of heart disease and stroke. Dr. Robert L True, an Anti-Aging Specialist from Colleyville, TX, has confirmed, ” The bad press produced by the WHI has caused more harm than good for the risks are actually very low, while the benefits very high.”

Several years after the WHI, the findings of the WHI were re-evaluated and it was found that the risks of HRT had been overstated particularly with respect to its cancer causing potential. Moreover, HRT could have benefits depending on the time of onset of menopause, health condition and the family history of the patients. However, there is a need for assessment of health condition plus the family history of the patients before HRT is recommended.

It is also now seen that earlier formulations were less safe in their dosage, mix of hormones and delivery method that is, through pills which go to the liver and may cause clots.

Way forward for HRT:

All these and a wider variety of hormone treatments available now make HRT dependent on close consultation between the patient and the doctor.

For most American women menopause symptoms start around the age 50 and there could be degradations in quality of life for a period ranging from two to twelve years. HRT can give relief to these women if their health conditions and other details permit.

In HRT, dosages depend on the individual conditions and It is important that the women seeking HRT not only consult with their doctors but also educate themselves to the extent possible about HRT.

Dr. Marina Johnson, a Dallas endocrinologist and pharmacist and author of Outliving Your Ovaries: An Endocrinologist Weighs the Risks and Rewards of Treating Menopause  With Hormone Replacement Therapy says “Some women need higher doses, some need lower doses. Once a woman is educated, then she knows what to go in and ask for. If a doctor won’t work with you, then find another doctor,”

According to Dr. Noushin A. Firouzbakht, an obstetrician-gynecologist at Texas Health Harris Methodist Hospital Fort Worth, despite the alarm caused by the Women’s Health Initiative study, much was learned, especially about the ideal candidate for hormone replacement.

Dr. True encourages women to embrace the benefits of HRT, “Women live well into their 80’s to 90’s now, why not live with a better quality of life using hormones.”

These opinions again underscore the need for self education and consultation with doctor by a potential HRT patient to determine if she is indeed an ideal or near ideal patient. This assessment is important as HRT is known to have risks for an individual who is not a good candidate.
Information for Potential HRT Patients:

Dr Firuzbakht says “We also learned that we see fewer strokes and heart attacks from non-oral methods like a patch or a cream.” The rule of thumb traditionally was that one should use it in the lowest dose for the shortest amount of time. Now, with this new data about transdermal estrogen, no longer do you need to stay away from hormone replacement therapy, but you do need to use it wisely.

This points to regular health appraisal including monitoring blood pressure, blood analyses, breast changes, side effects and finally if one is still a good HRT candidate. Women with breast cancer or at higher risk of the disease cannot take HRT.

On the other hand, despite the close surveillance that the HRT patients may suffer, there are certain positives, including getting a better quality of life post-menopausally, and other preventative actions that suitable patients gain from HRT. These are protections that HRT has been proven to provide against heart disease, dementia, colon cancer and osteoporosis.

Bio-identical hormone therapy (BHT), which uses identical hormones to those that naturally occur in the body during youth, may be different than those hormones commonly prescribed. BHT is getting a lot of attention due to the benefits they provide, but this also leads to added confusion about HRT. But the HRT patients should learn about such hormones too.

Dr. True prefers to use BHT because of the improved benefits they provide for women, including a potentially better quality of life. “When women have hormones of a youthful woman, this gives them a fighting chance to feel that youthful vitality, enthusiasm, sexual libido and zest like one sees in young women.”

Dr. Johnson says that she has no objection to use plant based (BHT) or equine based hormones provided these are “quality-controlled, safety-tested formulations that are made by pharmaceutical companies and approved by the Food and Drug Administration.”

But both Dr Firouzbakht and Dr. True prescribe only pharmaceutical hormones through pharmacies that develop bio-identical hormone combinations for some patients. Such custom compounds are not FDA approved. Dr. True also uses custom hormone therapies, titrated to each woman’s metabolism. He prefers to use hormone pellet therapy because he finds that these provide the best results.

They both agree that “It doesn’t matter what formulation of the hormones you are using, it’s the surveillance of it all that is very important. We need to know about side effects, unwanted adverse effects; those risk factors don’t go away with bio-identical hormones. When you have a good relationship with your gynaecologist, you will get what you need.”

So, what do all these finally mean to women facing or going through menopause?

It is that they should surely, if the symptoms are severe, investigate by self education and consultations with their doctors, if they are fit to take up HRT. After all HRT can give significant relief to some women while it may be risky for some others.

 [Source: This write up is sourced from the article Hormone replacement therapy regains popularity By DAPHNE HOWLAND The Dallas Morning News Published: 02 April 2012]