CHECK-UP: I'm having a rough time going through the menopause. Although I always said I'd never take HRT, my sister, who is also menopausal, finds it a great help. Should I take it?
Up to 2002 hormone replacement therapy (HRT) was routinely prescribed for the control of menopausal symptoms including hot flushes, vaginal dryness, mood swings, sleep disorders, and decreased sexual desire. However, when research into long-term HRT use highlighted the possibility of increased health risks in terms of cancer, coronary heart disease, stroke and venous thrombosis in HRT users, new recommendations on its use were established. Since then international drug regulatory bodies, including our own Irish Medicines Board, have been monitoring the medication and regularly update guidelines and product information when new safety data comes to light.
Is it likely to cause breast cancer?
There are different types of hormone replacement therapy. While some contain a combination of oestrogen and progesterone, others contain oestrogen only and are suitable for women who have had a hysterectomy. In terms of breast cancer, it seems there is still uncertainty regarding the increase in the incidence of this in women taking oestrogen-only HRT, with low or no risk observed in recent studies. However, the combined preparation recommended for most women is linked with a higher incidence of breast cancer, which is seen within two years of starting treatment. The risk is also related to how long the woman takes combined HRT.
Can HRT also increase the risk of clots in the veins and of heart disease?
Women taking HRT are at an increased risk of deep vein thrombosis (DVT) and of a clot travelling to the lung (pulmonary embolism) especially in the first year of use. If you have a personal or family history of DVT, you should discuss your personal risk with your doctor who may advise against prescribing HRT. In terms of heart disease, there is an increased risk of developing a blockage in the coronary arteries in women who start combined HRT more than 10 years after the onset of menopause. The risk may not be as great for younger women who start HRT close to the menopause.
