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Menopause

Menopause

Menopause without hormones

 

more wrinkles

Menopause without hormones

more osteoporosis

Menopause without hormones

more pain in muscles and joints

Menopause without hormones

more bowel cancers

Hormone replacement therapy and Breast cancer

Advantages of Hormone replacement therapy

No atrophy

  • of the vagina
  • of breasts
  • less dry eyes

Breast Cancer

  • Estrogens increase growth rate and thus :
    • the diagnosis is made 8 years earlier
    • a less aggressive cancer with lower mortality
  • Not more breast cancers
    • There are no data demonstrating that estrogens induce breast cancers
    • important is that the intervan between the onset and the diagnosis is generally some 20 years
    • accelerated growth means that the incidence of cancer diagnosis will be higher in woepmn taking hormone replacement therapy (odds ratio : 1.25)

Positive brain effects

  • less hot flushes and night sweats.
  • less depressions
  • less sexual problems
  • better sleep
  • Positief effect op de cognitieve functie bv geheugen
  • Minder kans op Alzheimer

Less cancers

  • 50% less bowel cancers
  • 50% less adenocarcinoma of the uterus ; (unless estrogen only therapy)
  • no effect upon cervical cancer
  • no effect upon ovarian cancer

Women taking hormones live longer

  • Women with ovaries live longer

Better support tissues

  • no osteoporosis
  • less wrinkles
  • less pelvic floor descent and urinary incontinence ,
  • less pain in muscles and joints
  • less thin skin

Positive caradiovascular effects

  • 50% less cardiovascular problems

if HRT is taken from the onset of menopause. After a delay of 5 years this effect disappears. This should be compared to flowers without water

Decision tree

  • I prefer to take HRT because of the advantages
    • What dose ? depends if the aim is to replace the natural hormones of to treat little problems only
    • with or without menstruation ?
    • For how long ? : there is no medical reason to stop HRT (similar to reading glasses to read) It can be wise after age 85 to decrease breast cancer incidence by slowing down growth.
  • Which hormones should I take : an experienced gynecologist will guide you through thus trial and error period (similar to trying on a new dress).
  • Which exams are necessary :
    • not more than usual
    • for the 2 yearly mammography it is better to stop HRT for a short period in order to decrease breast density.

Why are the perception and the press so negative for HRT

  • An overview is rarely available - most specialists see only their field of interest   eg the specialists in osteoporosis , cardiology, oncology etc.
  • The terror of breast cancer.  Since the growth of existing breast cancers is accelerated, more breast cancers will be found in the group of women taking HRT  (OR : 1.25) than in a control group. This often is erroneously translated as more breast cancers.  To judge an odds ratio of 1.25  you have to know that this is less than the effect of obesity.
  • Fear to do something not natural :  Mammals in the wild do not have a menopause ; menopause occurs only in the zoo ie with adequate food, housing and the veterinarian. This explains the slogan : a woman lives longer than her ovaries  ie biologically we were not programmed to reach that age .
  • Good news is no news : the press will highlight negative news .
  • Hormone replacement therapy requires a solid knowledge of endocrinology .
    • Each woman is different  with her specific  hormone balance. This can be compared with differences in colr of hair and eyes.  The same holds true for HRT which has to create the suitable climate.
    • Variable bio-availability. Resorption and availability of hormone varies at least 4 fold between women. Therefore that the dose of hormone has to be adapted.
    •  standard preparations are suited only for the standard woman
  • A problem of oncologic perception  Women with an existing breast cancer are treated after surgery with anti-estrogens in order to slow down growth and increase the tumor free interval.
  • Doctors with less knowledge of endocrinology together with prudence will give
    • As little hormones as possible    which teat little problems as vaginal dryness
    • Fytohormones  with unproven efficacy .
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