Hormone replacement therapy
Most women need hormone replacement which is similar to needing glasses to read.
Women should realise the ‘shoe shop’ syndrome’ of many clinicians. All shops sell shoes but only those from their shop and do not refer to other shops.
No atrophy
- of the vagina
- of breasts
- less dry eyes
Breast Cancer
- EXISTING cancers grow faster.
- thus the diagnosis is made 8 years earlier
- but the cancer is less aggressive (more estrogen receptor positive) and the mortality is lower.
- NOT MORE breast cancers
- There are no solid data demonstrating that estrogens induce breast cancers
- the interval between the onset and the diagnosis is estimated around 20 years
- because of the faster growth, the first 8 years, more ‘cancers’ are found in women taking HRT (odds ratio: 1.25). Unfortunately some physicians interprete this as more cancers.
- NEW: and overdiagnosis of breast cancers (an estimated 10 to 40% never had a cancer).
Positive brain effects
- less hot flushes and night sweats.
- fewer depressions
- less sexual problems
- better sleep
- Positive effect on de cognitive function, e.g. memory
- Less Alzheimer risk
Fewer cancers
- 50% less bowel cancers
- 50% less adenocarcinoma of the uterus ; (unless estrogen-only therapy)
- no effect on cervical cancer
- decreased mortality of ovarian cancer
Women taking hormones live longer
- Women with ovaries live longer
Better collagen
- no osteoporosis
- less wrinkles
- less pelvic floor descent and urinary incontinence,
- less pain in muscles and joints
- no thin skin
Positive cardiovascular effects
- 50% less cardiovascular problems
- if taken immediately after menopause
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.
Thrombosis
- irrelevant unless in women at risk
- normal risk is 2/10.000
- with hormone replacement 3-4/10.000
- oral contraception 6/10.000
Practical guide
- A routine treatment = ‘the average product with the average effect in the average woman’.
- Therefore Individualisation is needed. This requires experience
- which dose? since bioavailability in women varies at least 4 fold, dose finding is needed
- which estrogens/ which progestagens
- which regime i.e. with or without menstruation?
- For how long ?: there is no medical reason to stop HRT (similar to reading glasses to read).
- Which exams?
- no extra exams
- a mammography every 2 years. It is recommended to stop HRT for 2 months to decrease breast density. If a suspicious lesion is found read my suggestion to stop HRT for 3 months and to repeat the mammography instead of starting immediately a full exploration.
Why do not all doctors favour HRT
- insufficient knowledge of endocrinology and lack of experience
- to individualise therapy
- minimal standard treatment is not ok for most women
- lack of overview -> the field of interest varies between specialists in osteoporosis, cardiology, oncology etc.
- Misunderstanding breast cancer.
- Existing breast cancers grow faster -> earlier diagnosis -> more diagnosed during the first 8 years (OR: 1.25) -> mis-interpreted 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.
- Breast cancers diagnosed during HRT intake of HRT are more estrogen receptor positive -> less agressive with a lower mortality
- Fear of doing something not natural : Mammals in the wild do not have menopause; menopause occurs only in the zoo. This explains the slogan: a woman lives longer than her ovaries, i.e. biologically, we were not programmed to reach that age.
- Good news is no news: the press highlights negative news.
- A problem of oncologic perception Women with existing breast cancer are treated after surgery with anti-estrogens in order to slow down growth and increase the tumour-free interval.