Doctors Should Prescribe HRT To Menopausal Women, Says Health Watchdog
Doctors Urged To Prescribe HRT To Menopausal Women
Natasha Hinde— The Huffington Post UK
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More than one million women could benefit from hormone replacement therapy (HRT) to help them manage symptoms of the menopause, England's health watchdog has said.
The treatment works by replacing oestrogen which has been reduced in the body.
Safety concerns have previously been raised over HRT after a study showed women were more likely to develop breast cancer. This led to thousands of women shying away from the treatment.
But NICE said that women should be prescribed HRT because it can be extremely effective for symptoms including hot flushes, mood swings and depression.
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The guidelines contradict a study of more than one million women from 2003, which claimed HRT increased the incidence of breast and ovarian cancer.
NICE said that the breast cancer risk for women around menopausal age varies from one woman to another.
"HRT with oestrogen alone is associated with little or no change in the risk of breast cancer," read the guidelines. "HRT with oestrogen and progestogen can be associated with an increase in the risk of breast cancer."
According to NICE, any increase in the risk of breast cancer is "related to treatment duration" and reduces after stopping hormone replacement therapy.
The organisation hopes more doctors will discuss the possibilities of HRT with their patients, in a bid to make an informed decision about the best course of treatment for them.
The NICE guidelines also advise menopausal women who have had breast cancer, or have a family history of the disease, to speak to a specialist regarding suitable treatment options.
Dr Helen Webberley, the dedicated GP for Oxford Online Pharmacy, says women shouldn't be afraid of speaking up if they want the treatment. And equally, some GPs need to be better informed, too.
"Many women and doctors have been scared off HRT, although it is known to be very safe and effective," she tells HuffPost UK Lifestyle.
"I have a lot of requests from women wishing to receive HRT who have been denied the treatment by their GP.
"GPs can be ill-informed and scared of prescribing HRT and are not willing to have a proper discussion with their patients about the risks and benefits."
She adds: "Any woman who is under 52, when they go through the menopause, should be actively encouraged to have replacement therapy, and the option should be available for those over 50, with decisions being tailor-made after sound discussions.
"Some women currently feel that they need to be stoical and just 'get on' with the symptoms, but for many it is truly miserable.
"The risks need to be weighed up very carefully with the perceived benefits, and doctors need to be prepared to have this discussion in an evidence-based way with their patients."
Following the release of the new guidelines Professor Valerie Beral, who led the 2003 'Million Women' study linking HRT to breast and ovarian cancer, told the Guardian that there's still a risk.
"About one million UK women are currently using hormones for the menopause," she said.
"Among them, about 10,000 extra breast cancers are estimated to occur in the next 10 years [40,000 in total, instead of 30,000 if the women had not used the hormones].
"Also about 1,000 extra ovarian cancers are estimated to occur among them in the next 10 years [6,000 in total]."
11 Things You Need To Know About Menopause
What Is It?(01 of11)
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Menopause is when a woman’s menstrual periods cease because the ovaries are no longer producing estrogen and progesterone (a hormone). Once menopause starts, a woman is no longer able to become pregnant. The time period leading up to menopause, when estrogen and progesterone levels are changing and periods can become irregular, is called perimenopause. According to the Office on Women’s Health in the U.S., a woman is considered to have gone through menopause if she has not had a menstrual period for one year — cancelling out other reasons that would cause menstruation to cease, like illness, pregnancy and breastfeeding. Menopause can occur over a wide range of ages, but early 50s is the average, and the menopausal transition can take from two to eight years. (credit:Dorling Kindersley via Getty Images)
Know The Symptoms (02 of11)
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Common symptoms of perimenopause and menopause include irregular or absent menstruation, sleeplessness, hot flashes, night sweats, vaginal dryness, painful intercourse, mood changes, and increased vaginal or urinary tract infections. Some of these symptoms may continue for months or years after a woman stops menstruating, the Office of Women’s Health notes. Tracking symptoms can provide your doctor with helpful information on handling them, and give you a way to anticipate when they might occur. (credit:YunYulia via Getty Images)
But There Are Unusual Symptoms As Well (03 of11)
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"Patients are often surprised to learn that mood swings, depression and sexual dysfunction can also occur,” says Dr. Nina Ali, a gynaecologist with The Menopause Center at Texas Children’s Pavilion for Women. "Joint aches and pains and skin changes are sometimes present as well.” Some women may also experience weight gain around their midsections, or lose muscle and gain fat. Changes in sexual desire and drive (up and down) are also possible. (credit:Cavan Images via Getty Images)
Take A Deep Breath (04 of11)
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Some women find relief from hot flashes through relaxing exercises like paced breathing training or meditation, Ali says. When a hot flash starts, practice your preferred mindfulness technique to get some relief from the symptoms. (credit:Michaela Begsteiger via Getty Images)
Exercise And Eat Well(05 of11)
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Staying active during menopause is important, because it helps maintain bone density, muscle mass, and metabolism, Ali says. It’s also important to make sure you get enough calcium to maintain healthy bones: the Office on Women’s Health recommends 1,200 mg of calcium daily for women older than 51, along with 600 IU (international unit) of vitamin D and 800 IU if you are older than 70. If you have experienced menopause but still have vaginal bleeding due to hormone therapy, you may need iron supplements as well. (credit:Tomwang112 via Getty Images)
Stay Cool(06 of11)
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Staying cool overall can help make hot flashes a lot more bearable. Dr. Robert S. Wool, an OB/GYN with Women’s Health Associates suggests adding air conditioning and cool baths to your daily routine. (credit:David Arky via Getty Images)
Consider Herbal Relief (07 of11)
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Some non-hormonal treatments have been shown to provide relief, Dr. Wool says, including a black herb called cohosh. There is some preliminary clinical evidence that black cohosh can provide short-term relief from menopausal symptoms, according to the National Institutes of Health in the United States. Be sure to let your physician know about any herbal supplements you take, in order to avoid harmful interactions with medication. (credit:Foodcollection RF via Getty Images)
Hormone Therapy May Be An Option For Some(08 of11)
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Though it has been very controversial, for some women hormone therapy is safe and provides more benefits than risks, Ali says. "Women who are good candidates for hormone therapy are close to menopause, typically ages 50 to 59, are in good health, do not have cancer, liver disease, unexplained vaginal bleeding, or a history of heart disease or blood clots,” she says. The risks vary with age, she adds, and the therapy is more beneficial when you start at a younger age. "Hormone therapy can effectively relieve hot flashes, vaginal dryness and night sweats,” she says. "Hormone therapy can also protect the bones from osteoporosis, lower the risk of type 2 diabetes, and help with mood and memory.” (credit:hatchapong via Getty Images)
But Be Aware Of The Cautions (09 of11)
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Wool also advises that hormone therapy can be relatively safe in most patients, but gives a few warnings. "There are certain concerns and that would be an increased risk of stroke, an increased risk of VTE or venothrombotic events such as a blood clot in the legs or lungs,” he says. "Plus, the data on breast cancer is not out. There’s mixed feelings on whether or not hormone replacement increases breast cancer.” Each individual patient should speak with her physician to outline her own profile for risks and benefits. (credit:PelageyaKlubnikina via Getty Images)
It May Not Be Menopause (10 of11)
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It’s important to pay attention to changes in your body because the symptoms associated with menopause can have other causes as well. Hot flashes could also be a result of thyroid dysfunction, medication side effects, stress, or fever, Ali notes. For younger women, night sweats could be a sign of infection, lymphoma, or leukemia, Wool says, adding that vaginal dryness should be addressed at any age. And when it comes to the lack of sleep many menopausal women experience, it could be related to environmental factors like stress and anxiety, Ali says. (credit:Jetta Productions via Getty Images)
Take Care Of Your Medical Business (11 of11)
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Preventive care becomes even more important during and after menopause, Ali says, and this includes screening for breast, cervical, and colon cancers. Talk to your physician about your personal risk profile for these conditions and go over the current screening recommendations to find out what you need to have checked. Also, keep up your yearly medical exams, Dr. Wool says, so you have a forum for discussing concerns about menopause with your physician. "There’s a lot of misinformation out there in addition to a lot of different opinions,” he says. "It is important that every woman has this discussion with her own practitioner." (credit:SelectStock via Getty Images)