WOMEN’S HEALTH Hormone Replacement Therapy Dr Michael Flynn Some may say it is a time of anxiety. That biological clock alarm is about to go off. You have been warned about the hot flushes, and all the things happening at that time of life. You have been told that every little symptom you feel is just a matter of age and that’s just what you have to accept. But do you accept it or question it? For many women, menopause is surrounded by confusion and the medical profession has been one of the main perpetrators of women’s anxiety with their message changing constantly. On top of this, there are regular media reports about cancer risks and risks associated with hormone replacement therapy. So what is the real story and what is considered best practice today? Hormone replacement therapy (HRT) was the mainstay treatment 20 years ago. Every woman reaching menopause would commence HRT and no one battled hot flushes or had concerns about osteoporosis. The bigger question was when to cease HRT and which women should be restricted from it. Then along came The Women’s Health Initiative, which was a worldwide study giving outcomes suggesting an increased risk of heart attack and stroke if HRT was undertaken for more than five years. Immediately, all prescriptions ceased and women looked at alternative options, many of which had been less studied than HRT. Hot flushes, osteoporosis, mild urinary incontinence symptoms and painful intercourse became reasons women sought help, now that HRT was not being used. More subtle, but equally important, concerns of cognition, thought processing and longerterm dementia due to hormone deficiency came to light, Further investigation into the findings of The Women’s Health Initiative has indicated that their findings are not black and white. The complications of HRT seemed to focus on women who started HRT in their mid 60s. New research is now suggesting a possible ‘window of opportunity’ with many symptoms including dementia and cardiovascular risks decreasing if oestrogen is given prior to commencement of menopause, but possibly increasing if commenced more than 10 years post menopause. Best medicine today is the individualisation of care. Hitting 50 should be the exciting commencement of the next phase, rather than the anxiety of winding down. My best advice to make 50 the new 40 is: 1. Have a yearly check up with your GP. Minor medical problems are best dealt with early. 2. Increase the focus on healthy living. Diet and exercise become more important. A diet rich in Vitamin E, Folate, B12 and mega-3 fatty acids may be protective against cognitive decline. Age is not an excuse not to attain that exercise goal. 3. Do not be afraid of exploring oestrogen replacement. There are only a few absolute contraindications and the long-term benefits may be significant. Natural oestrogens and progestagens seem to have the lowest risk and you do not require blood testing to confirm benefits. 4. Make a pledge to start brain exercises. There is strong evidence that daily mental stimulation decreases dementia risks. 5. Do not accept that normal activities like sex and intimacy have to change. While thinning of the vaginal skin after menopause with subsequent painful intercourse is a very common complaint, reparative treatment like vaginal laser, which requires minimal downtime will restore moisture and stop the pain and dryness that make many women shy away from intimacy. Relations mature and evolve but should not stop. 6. Have osteoporosis assessment. Bone thinning is a significant medical problem in later life, which can be avoided. 7. Do not neglect breast cancer screening. Following these simple steps can help you to embrace one of the most exciting times in your life with a positive outlook! pindaramagazine.com.au Pindara Magazine 41
Pindara Private Hospital Magazine - Issue Six
To see the actual publication please follow the link above