Menopause Treatment: Advantages and Disadvantages of HRT

There are many research trials which show that women who take HRT have better bone density than women who don't, but the trials generally don't look at lifestyle, ethnic and dietary factors when comparing women. Research does show that being thin, European or Asian, smoking and drinking a lot of alcohol increase a woman's likelihood (risk factor) of suffering from osteoporosis. There doesn't appear to be any information on exercise and dietary effects on risk factors. To gain this protective effect, HRT is recommended for peri-menopause and several years beyond menopause. Some experts suggest that 15 years is optimum for effect. This advice conflicts with evidence that the risk for breast cancer increases slightly for every year a woman takes HRT.

The risk for thrombosis (clots blocking a blood vessel) is also increased by taking HRT because exogenous (medicinal) oestrogen increases clot formation. It is possible that diet and exercise may offset this risk, but unfortunately there is no research into this type of 'combination therapy'.

Oestrogen-only therapy protects the heart and lowers cholesterol, which may help to avoid gallstones but progestogens greatly reduce this protective effect. Oestrogen-only therapy clearly increases the risk of womb cancer, even when applied as a cream vaginally. There doesn't appear to be any evidence that HRT helps insomnia, although it is frequently suggested that it might.

Who should and should not take HRT?

To summarise, women who have a family history of breast or womb cancer, or of thrombosis and women who have varicose veins or are obese should be advised not to take HRT.

The Committee on Safety of Medicines recommends that women without these risk factors should take HRT for a short time around menopause to help to avoid what they describe as a small increased risk of breast cancer, associated with longer term use of HRT. They feel that the benefits of HRT outweigh the risks. Women with a diagnosis of osteoporosis should consider using HRT as a therapeutic agent, unless other factors prevent it. Unfortunately, heavy smokers and drinkers also have risk factors for heart and circulatory disorders as well as cancer. Menopause could be a good time for them to change their habits, so that more options are open to them with less associated risks.

The side-effects of HRT

Many women complain about annoying side-effects of HRT, which they often say are worse than the symptoms of menopause. Water retention, weight gain, breast tenderness and bloating head the list, with migraine, indigestion, nausea, constipation and fibroid problems following close behind. These effects result from the larger dose of hormones entering the body all at once, or in amounts which upset the balance achieved by the natural feedback systems.

Concerns about these effects and what many women see as medication without a cause, make women look for alternatives.