Thursday, April 29, 2010

HRT - The Risks And Benefits

Thursday 29th April 2010

Hormone replacement therapy is commonly prescribed in women with severe menopausal symptoms. HRTs also have been found to have beneficial effects on osteoporosis, coronary heart disease and colorectal cancer, and this has led many women to also use them in the hope of reducing their risks of these conditions.

However, in recent years, the use of HRTs have dropped significantly due to the publication of the findings of the Women's Health Initiative Study.

The Women's Health Initiative (WHI) Study is the largest randomised controlled trial on one combination of HRTs. Conjugated equine estrogen 0.625mg plus medroxyprogesterone acetate 2.5 mg was compared against a placebo in 16,608 healthy postmenopausal women aged between 50 to 79 years, with an intact uterus from 40 North American centres over a planned 8.5 years. One of the study's components examined the role of HRT in the prevention of major degenerative diseases (cardiovascular disease, osteoporosis and cancer).

This component of the WHI Study was stopped prematurely on 31st May 2002, after 5.2 years by the data and safety monitoring board, due to an increased risk of invasive breast cancer, cardiovascular disease, strokes and pulmonary embolism. Reduction of risks were observed in endometrial cancer, hip fractures and colorectal cancers. Since the overall health risks exceeded the benefits, it was concluded that combined estrogen-progesterone is probably only suitable for short term treatment of early menopausal women with significant menopausal symptoms. In general, menopausal symptoms will resolve within 5 years spontaneously.

HRT & Menopausal Symptoms:

HRT is effective in the treatment of menopausal symptoms (in particular, vasomotor symptoms, vaginal dryness and urinary symptoms), thus improving the quality of life in women who suffer from significant symptoms.

HRT & Osteoporosis:

HRT reduces the risk of osteoporosis and its subsequent fractures. However, in view of the associated risks of HRT, alternatives such as bisphosphonates should be used instead.

HRT & Colorectal Cancer:

HRT reduces the incidence of colorectal cancer, however, combination HRT should not be used sole for this purpose due to its associated long term risks.

HRT & Coronary Heart Disease:

Current evidence has not demonstrated any benefit in use of HRT in reducing the risk of coronary heart disease.

HRT & Dementia:

There is no evidence to suggest that HRT improves cognition or protects against dementia.

HRT & Breast Cancer:

Long term HRT use (more than 4 years) is associated with a small but significant increase in risk of invasive breast cancer. The breast mammographic changes on that occur with HRT use may also hinder the diagnosis of breast cancer.

HRT & Endometrial Cancer:

Combination HRT has been shown to reduce the risk of endometrial cancer.

HRT, Deep Vein Thrombosis & Pulmonary Embolism:

Combination HRT use has been associated with significantly increased risk of deep vein thrombosis and pulmonary embolism.

HRT & Stroke:

Combination HRT use has been associated with a small increase in ischaemic strokes.

Dr Ang C.D. is has been in medical practice for over 12 years. He graduated with an M.B.B.S. degree from the National University of Singapore in 1997 and subsequently completed his post-graduate diploma in Family Medicine.

He has had training in Emergency Medicine, Internal Medicine, Geriatric Medicine, Orthopaedic Surgery, Obstetrics & Gynaecology, Neurosurgery, General Surgery, Colorectal Surgery and Urology.

Dr Ang currently practices in a family clinic in Singapore, seeing a good mix of paediatric, adult and geriatric patients.

With the goal of providing local and international patients with a resource for specialist care in Singapore, Dr Ang has founded, a Web Directory of Specialists in Private Practice in Singapore.

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