Is there life after HRT?
 There was once a time when women experienced a
natural process called the menopause. The
majority went through it without getting too hot or bothered. But a minority experienced intense flushes and night
sweats, excruciating headaches or thinning of vaginal tissues that made even walking painful.
If they went to their doctors the response would often
be (yawn yawn) ‘It’s just the
time of life… everyone goes through it…
get a hobby…’ kind of stuff.
But from the second half of the last century, the
menopause had a major makeover. The main reason
was the increased knowledge about HRT, hormone replacement therapy designed to make up for
the seasaw effect of diminishing oestrogen. A few
women got it and raved about it. There was the good
hair and skin effect as well as a magical diminishing of the horrible symptoms.
Result: more women went to their GPs requesting their
slice of the miracle treatment. They didn’t
always get it. At that time the GPs were unsure of
their ground. Media coverage of evangelical,
anecdotal reports are not the same as sound medical research. And, let’s face it, many GPs still held the view
that women should shut up and put up with a natural process.
But then evidence about osteoporosis and the
protective effect of HRT began to emerge. This
meant that fewer women would suffer the pain of bone thinning and fractures. There was
talk that HRT could also protect against heart disease and dementia (evidence now suggests
the opposite, with increased risk associated with taking the treatment).
Now it was the medics’ turn to get evangelical. GPs were encouraged to prescribe HRT, not just for a
couple of years to see women through the symptoms, but for life.
True, a few side effects were beginning to show up. Women with intact wombs were advised to take the combined
form of HRT, oestrogen with progestogen, to guard against increased risk of cancer of the
lining of the womb. There were also a few
statistical hints about risk of breast cancer, especially after 5 years of use, but by
this time the leading consultants were on a roll.
In my researches (for books on the menopause and
editing a newsletter on the subject) I came across hardened attitudes from the experts
at this time. One told me without flinching that he would put his daughter on the
contraceptive pill at 16 and then switch her to HRT at around 45 for life (he has, in the last couple of years, had a complete
change of mind on this). Another flatly denied the
need to curtail use of HRT for up to and even beyond 10 years. At meetings held by pharmaceutical companies, the
worries and queries from health professionals were reassuringly dismissed.
The menopause had become medicalised. Doctors wanted women to be treated for it. Women wanted
to be treated.
What do these women do now, with confirmation that
risk of breast cancer is a real danger, and risks of heart disease, stroke, dementia are
all adding to the doubts?
Some doctors are all ready to pass the buck, saying
that it is up to individual women to weigh up the facts for themselves. Trouble is, who really knows the facts? And who do you trust? Some
specialists say that taking HRT for one or two years is fine, others say only one year. Not madly helpful.
The real test for the consumer must
be: how bad are the symptoms? This may seem
obvious, but it actually means giving up the concept of a keep-young-and-beautiful
lifestyle treatment (which was always pretty dubious anyway). It also means exploring alternatives, including other
medications that can protect bones more effectively than HRT, or nutritional supplements
that may reduce hot flushes and other menopausal symptoms. Then there’s the healthy
diet, no smoking, less alcohol and lots more exercise to help strengthen bones.
HRT was never the complete answer
and sadly it was oversold.
 Helen Franks wrote several books and magazine features on the menopause including `Boneboosters, Natural
Ways to Beat Osteoporosis` (with Diana
Moran, published by Boxtree, now out of print but
possibly available through Amazon). She has
also edited the newsletter of the Amarant Trust, on this subject.
For
information on alternatives to HRT, click onto Helen’s Healthwise column.
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Talkback is a regular
feature in laterlife.com run by journalist and author Helen Franks. 
