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 Women's Health

May 2012
The HT Divide:
The Woman At 40 Against The Woman At 60
Dr A Jaishree Gajaraj
 
The verdict is still out on the benefits of hormone therapy for menopausal and post-menopausal women. But there is a window of opportunity, which women need not deny themselves, while time is on their side.

Menopause, hormones, hormone therapy, hot flushes, osteoporosis, increased risk of heart attacks – such is the interpretation and understanding of menopause and its implications. Myths about menopause have often prevented women from seeking help from doctors and condemned them to suffer in silence lest they be forced to take hormone therapy More than half a century ago, the benefits of estrogen therapy were abused by Hollywood stars. It was known and used as an elixir of youth. Over the years, our understanding of menopause, menopausal health and hormone therapy has undergone many changes.

Menopause And Hormones
As a woman nears menopause (cessation of monthly periods), certain hormonal changes take place. There is a decline in the function of the ovaries with a concomitant decrease in production of the hormone called estrogen in the woman’s blood. There is a parallel decrease in bone strength (reduced bone mineral density) and an increase in risk of heart attacks. She also suffers from sudden hot flushes and mood changes. On the whole, she is often left wondering why? Why me? A simple solution seems to be to replace the deficient estrogen.

But does replacement equal wellbeing sans complications? Will she benefit from hormone therapy? Will hormone therapy harm her? So, what exactly is the risk of heart disease at menopause? A dilemma indeed!

Assessing HT
Hormone therapy has its advantages and no woman should be denied this. It should only be prescribed after thorough investigation. The need for and the benefit of hormone therapy should be assessed carefully. The International Menopause Society now recommends hormone therapy only as a short-term option to women with symptoms around menopause. It should be individualised and tailored to the requirement of each person.
  • HT should be avoided for the sole purpose of preventing heart disease, especially if the woman is postmenopausal and over 60 years.
  • Scientific evidence indicates a slightly increased risk of heart attacks in the first two years of commencing HT in older women.
  • On the other hand, in women below 60 years, recently menopausal and without evidence of cardio vascular disease, there is definite benefit.
  • It has a positive effect on the blood vessels and their function, in lowering cholesterol and blood sugar levels and on blood pressure.
  • Whilst HT should not be started in older women, it is beneficial in women when started around the age of menopause to prevent coronary artery disease. This is known as the “window of opportunity”.
A 46-year-old woman would probably benefit greatly by taking hormone therapy. It is more important to advise her on lifestyle modifications like a healthy diet and planned (preferably supervised) exercise. One should also stress the importance of regular medical supervision as she continues treatment.
Dr Arcot Jaishree Gajaraj Senior Consultant Gynaecologist, Apollo Greams Hospitals, Chennai.

    
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