HYSTERECTOMY: HORMONE THERAPY
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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Tags: Women’s Health