Health related information and news from around the world.

Hormone replacement therapy isn’t right for every woman. Some can’t take it because of medical conditions they either have or are at risk of having; some are completely turned off by the various side-effects; others don’t want to take it because they believe it is unnatural, interfering with nature. Women who spent most of their reproductive years on the Pill may now want to have a break from all hormones; and many don’t want to ‘pop a pill every day’ to prevent conditions they haven’t got and may never have.

If you are in the lucky 20 per cent who sail through the menopause with hardly a symptom to complain about, you will probably not give HRT a second thought. Osteoporosis and heart attacks seem far away on life’s distant horizon. However, if you feel you are at risk of developing either of these conditions, then HRT is a form of prevention you should think about – it is not just for treating hot flushes.

Of the remaining 80 per cent who get menopausal symptoms, only a very small proportion at present take HRT, although their number is now growing steadily as women understand more about it, and doctors feel more confident about prescribing it. Even so, many women are still unable or unwilling to receive hormone treatment, so what else is available for diem at this time?

There are many and varied ways of coping with the different symptoms that afflict menopausal women. Some involve taking medication of different types, others involve making lifestyle changes. None of them is a true replacement for oestrogen, and it really is worth keeping this thought at the back of your mind, especially if you want to protect yourself from osteoporosis and coronary heart disease.

As we get older, we must work at being healthy. We can no longer abuse our bodies and expect to get away with it. The teenager or young woman who smokes, drinks and takes no exercise probably won’t notice the effect for many years; for the older woman it is different – suddenly these habits affect her life now.

Smoking, coffee and alcohol all make vasomotor symptoms (hot flushes and night sweats) worse; alcohol and tobacco lower the oestrogen supply; alcohol also interferes with the body’s effective use of calcium; taking no exercise increases the risk of getting osteoporosis and a heart attack. Isn’t it unfair!

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Women who have had hysterectomies or who are on certain drugs to control endometriosis are more likely than average to be prescribed hormone therapy (sometimes referred to as hormone replacement therapy or HRT). The following points should be taken into account when making a decision about whether hormone therapy is suitable for you.

• Oestrogen is effective in relieving hot flushes and night sweats, vaginal dryness and some urinary symptoms.

• Hormone therapy is particularly helpful to women who have had a premature menopause, whether it has been natural, or medically or surgically induced. They are likely to benefit most from it because they tend to suffer more extreme symptoms of menopause and are at an increased risk of osteoporosis and diseases of the heart and blood vessels, and because in many cases they no longer have a uterus and so the hormone therapy tends to be simpler (oestrogen only is usually prescribed, but sometimes progestogen or testosterone are added).

There is some evidence that oestrogen used on its own may offer protection against heart and blood vessel disease. This benefit is heightened for women who have had an early menopause. The decision about which hormone preparation is suitable for women who have not had a hysterectomy depends on the balance between several potential benefits and hazards. There are gaps in information on both sides that research will start to fill during the rest of this decade.

In deciding whether to undertake hormone therapy for prolonged periods in the absence of worrisome symptoms, women should take account of both the anticipated benefits and the possible risks. One of the benefits of oestrogen use is that it postpones bone thinning and reduces the likelihood of heart disease. When combined with a progestogen, there are still significant benefits for bones, but progestogen appears to negate some of the protective effect that oestrogen has on the heart and blood vessel system. In regard to the risks, the biggest concerns lie with cancers of the breast and endometrium. Breast cancer is the most common cancer of the reproductive organs and the one most feared by women, so consideration of the link between oestrogen and breast cancer is sometimes tremendously important in helping women decide about hormone therapy. If, for a particular woman, the avoidance of an increased cancer risk is more important than the benefit in terms of osteoporosis or cardiovascular disease, this is clearly the basis on which her treatment should be decided. In making a decision, it is important that women take account of their family history of breast cancer, strokes, heart disease and osteoporosis and that they try to identify the cause of death of all close female relatives.

For many women, drawbacks to combined oestrogen and progestogen include withdrawal bleeding, breakthrough bleeding and PMS-like side-effects, and the possibility that hormone therapy may increase the risk of breast cancer, especially in women with a family history of this cancer. For women who use oestrogen on its own and who still have a uterus, an important consideration is the need for regular and extended monitoring to detect any early changes suggestive of cancer of the uterus.

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Unresolved grief reaction. Is there anything we can do to ease the grief reaction? Not really. In fact grieving is to be encouraged, so that the locked up energy generated from the stress reaction can be expressed and shared. A person can be affected in the future if this locked up energy is allowed to remain inside. This is called unresolved grief reaction and can be damaging. One patient who was referred to me, a young lady, had agoraphobia after the death of her father. She was using up all her time to help her grieving mother and did not grieve for herself. Her mother was depressed and suicidal. The patient was young and just married, she moved in with her mother to comfort her, and was afraid to show her own emotion, as she was afraid this could harm her mother. Her mother got better, but the daughter fell ill and this lasted for many years afterwards.

Acceptance. The next phase of healing is acceptance of what has happened. A homeostatic peaceful rearrangement or a new balance of the psyche is reached. The person may be badly scarred, but may find life has a different meaning or that his feelings and experiences may now be in a different level of existence. Extraordinary stress sometimes changes a person for the better. Things that he used to take for granted are now treasured. Happiness is now more like a spice in life, a gift rather than a necessity.

Insomnia. Sleep may be a problem in the initial phase. But most patients do not want any sleeping medication. They want to feel the pain and want the wound to heal in its natural way. There will always be a scar. But they treasure the experience and look back on it occasionally. Once an equilibrium state is reached, most people are able to continue their normal life. They will never forget this kind of extraordinary stress and the loss they can never replace. Somehow life goes on and the sun is always up the next day.

We normally cope adequately with most stresses, but there are occasions when the coping mechanisms fail. We call this a nervous breakdown, and in such cases professional help is called for, as medications and other forms of treatment are sometimes indicated.

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