Hormone replacement therapy or HRT is an important issue for women and their families. Like the combined contraceptive pill, it has been studied, praised, maligned, loved and feared. And the potential harm of HRT is discussed almost daily.
Some women go through natural menopause without problems, while others need support for symptoms and disorders in the later
stages of life.
However, whilst most women know that Estrogen in HRT is the hormone that needs to be replaced, many women do not know that Estrogen in HRT is, in fact, far weaker than Estrogen of the ovaries or Estrogen of the combined contraceptive pill. There might also be a fear that Estrogen of HRT is actually stronger than natural Estrogen. It is not.
Secondly Progesterone, the second hormone of HRT is only necessary if a woman who received Estrogens (from the ovaries, the contraceptive pill or HRT) has a uterus. When there is no uterus, then Progesterone hormone is not necessary.
The benefits of HRT include improvements in vasomotor (symptoms related to stability of blood vessels) activity, physical and psychological activities.
The problem is that there is a gap in how many people appreciate HRT. And this is not to relate to knowledge about the risks and benefits - a great deal is known of this. The gap is in the research that is often quoted.
Most research on HRT has been observational, meaning that those in the research have just been observed, and not specifically given one drug or another. These studies have reported various strengths of association between various diseases (such as breast cancer, venous thrombosis, heart attacks, strokes, osteoporosis) and HRT.
What these studies cannot report is, for example, that 'HRT causes breast cancer' or that 'HRT prevents heart attack' - although most people believe that these reports have done so.
The type of research that can say 'HRT causes breast cancer' was published in 2002, 2004 and the later confirmed in 2006 (www.whi.org). These are very valid studies because they employ techniques such as randomisation (each participant has an equal chance of receiving the HRT or identical non active tablet or placebo), they included thousands of women who were satisfactorily followed up for 5-7 years.
Both studies were successful from the point of view that they answered questions like: Does HRT cause breast cancer or prevent heart disease?
The first study in women with a uterus (www.whi.org 2002) clearly showed that HRT increased the risk of breast cancer, venous thrombosis, strokes, and decreased the risk of osteoporosis and colon cancers when compared to placebo, over a 5 year period.
The second study in women without a uterus (www.whi.org 2004, 2006) clearly showed that Estrogen replacement therapy or ERT (as opposed to HRT which includes progesterone) still increased the risk of strokes; ERT did NOT increase the risk of breast cancer and venous thrombosis; ERT decreased the risk of osteoporosis, but not of colon cancers when compared to placebo, over a 7 year period.
Progesterone would seem to be the problem with the breasts and thrombosis, and this is medically logical. Therefore for the woman with a uterus, protection with progesterone is important, and should be supplied in a manner that avoids these harms.
At the HRT clinic these issues can be discussed and a rational evidence-based approach taken.
HRT Consultation
Step One - Assessment of symptoms
Vasomotor symptoms
Hot flushes
Night sweats
Headaches
Insomnia
Migraines
Physical symptoms
Easy exhaustion
Central weight gain
Fragile hair
Fragile nails
Wrinkles
Genital collapse
Psychological symptoms
Mood problems
Anxiety
Depression
Others
Lack of libido
Poor memory
Poor concentration
Lack of confidence
Step Two - Menopause-specific quality of
life questionnaire
Step Three - Transvaginal examination of ovaries
and uterus
Step Four - Assessment of your HRT needs
Blood tests to estimate the levels of Follicule
stimulating hormone (FSH) and Estradiol.
Step Five - Recommendations
Discussion of individual risk of using HRT
Discussion of HRT and alternatives
Contact Hormone Replacement Therapy Clinic
The London HRT Clinic
The City of London Medical Centre,
11-13 Crosswall,
London EC3N 2JY Telephone: 01245 351676
The Essex HRT Clinic
The Regency Clinic
38 Ingrave Road
Brentwood CM15 8AH Telephone: 01245 351676
Appointments: Mrs Jane Bentley 01245 351676, 07876 490658
Coming to see us directly OR do you need a doctor's letter? You do not need a doctor's letter to make an appointment to see us. At the end of the consultation, you will be given a summary of the consultation to give to your doctor. However, if you do have a doctor's letter, then we will also be happy to see you with it.