When a woman reaches the age of hot flushes etc. the question of HRT has to be considered. Current evidence suggests that, when given with a progestogen, the benefits of HRT far outweigh the small risks, unless there are clear contra-indications. The overall benefits can be summarised as follows:-

Symptomatic improvement in Oestrogen-deficient symptoms, ( vasomotor instability, mood swings, vaginal dryness ) in the majority of women.

Reduction in ischaemic heart disease and cerebrovascular disease - blood pressure falls in the majority.

Protection against fractures, secondary to osteoporosis, at least when HRT is used before the age of sixty when loss of bone mass is maximal

In HRT, oestrogen should be given cyclically with a progestogen, if the uterus is present, to prevent endometrial carcinoma from unopposed oestrogen action. There are some individual risks from oestrogen therapy, such as migraine and thrombosis but these may not parallel those of the 'pill' as the oestrogen dose is much smaller. The main concerns have been with induction of cancer of breast and uterus. Given with a progestogen, the risk of uterine cancer is not significantly increased, while the figures on breast carcinoma are conflicting. Unless the woman has had a hysterectomy, the inconvenience of withdrawal bleeds has also to be taken into account.

HRT can be given orally or administered via skin patches. The duration of treatment is controversial but ten years is a frequently quoted figure. Side effects can occur with oestrogen; these include nausea, headaches, weight gain, breast tenderness and fluid retention. If, however, a woman is suffering badly from the symptoms of the menopause, it may be worth a trial. Obviously it is an individual decision and should be discussed with your doctor.

For the duration of treatment, blood pressure and weight should be monitored and breasts examined regularly.

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