The bene-fits of hormone replacement therapy in post-menopausal women outweigh its side-effects
THAT the administration of the female
hormone oestrogen to post-menopausal
women prevents the tribulations associated with the painful process of menopause, has been common knowledge
since the late 60s. Many women and their
physicians considered this hormone as
the closest thing in modern medicine to
aIn elixir ofyouth, a drug that slows down
the ravages of time for women.
Hormone replacement therapy
(HRT), in which women are given
oestrogen and progestin after men 'o-pause to reverse bone weakening or
osteoporosis, among other things, JaS
remained a contentious issue with conflicting reports on risks and benefits.
HRT is known to increase the risk of
breast cancer and endometrial cancer,
while decreasing the risk of coronary
heart disease (CHD) and hip fracture.
Post-menopausal women are a difficult
choice, as many fear breast cancer more
than heart disease, whereas more
women die of heart disease in America
than of breast cancer. The chances of
developing breast cancer are one in
eight, compared to one in two for CHD
in such women. In the us alone, breast
cancer claims 43,000 lives every year, as
compared to CHD, which kills 233,000,
and hip fracture, accounting for another
65,000. Many physicians therefore consider that the benefits Of HRT far out-
weigh the slight chance of developing
breast cancer.
To assist such women and their
physicians in deciding whether to
administer or withhold HRT by anticipating the its effectiveness and risks, a
team of researchers led by Nananda F
Col ofthe New England Medical Centre,
Boston, analysed data from a 12-year
study of nearly 300 women aged
between 30 and 74, some of whom were
undergoing HRT, to study their life
expectancy. They concluded that
millions of women may well be missing
out on up to three and a half years of
life by failing to take the advantage
HRT offers. The study points out that
the benefits Of HRT, in reducing the
likelihood of developing CHD, far
outweigh the risk of breast cancer for
nearly all women in whom this treatment is considered (journal of the
American Medical Association, Vol 277, No 14).
The oldest and most familiar use of HRT is to relieve the hot flushes, night sweats, vaginal dryness and other symptoms of 'oestrogen withdrawal', that
occurs around menopause, when the
production of oestrogen by the ovaries
starts decreasing. A recent study, called
Nurses' Health Study, which followed
120,000 nurses for more than 10 years,
found that post-menopausal women on
oestrogen have about half the incidence
of heart disease as compared to
AM! those who did not take the horafr"@4, mones. HRT seems to improve a
women's ratio of good cholesterol (HDL) to bad cholesterol
(LDL), also maintaining the pliability of the blood vessels and
reducing the risk of blockage.
In addition, oestrogen is an
effective means of preventing
osteoporosis, the thinning of
bones that makes older women
so vulnerable to fractures, particularly of the hip. Several small
trials have also shown that
oestrogen improves memory for
post-menopausal women and
may benefit, even if in a small
way, women with Alzheimer's
disease. HRT also helps preserve
skin elasticity and general muscle
tone. It helps maintain the collagen, that make the skin looking
plumped up and moist.
Women who stand to gain
from the findings of the study are those
with a low risk of breast cancer and high
risk of heart disease. The study says they
can expect to live 41 months longer on
an average, if given the treatment. But
experts are cautious about recommendations to women of other countries,
given the varying life styles and diets,
and other social constraints. Ideally,
they would like a controlled international clinical trial to see that the benefits of this research reach women all
over the world. HRT may benefit women
already enjoying a healthy lifestyle, as it
further reduces the risk CHD.
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