Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
IS HRT SAFE? Rosol Hamid Consultant O&G What is safe? • Driving • Swimming • Crossing the street • Cycling • Riding a motor bike • Parachute jumping • Flying Evolution & controversy Over 20 years HRT changed from being the elixir of youth to being considered extremely risky British Menopause society& Women Health Concern recommendations 2013 • Informed choice • Annual evaluation • HRT before 60 has a favourable benefit/ risk profile • Premature menopause encourage HRT until natural age of menopause • Over 60 use low dose /transdermal Effects of HRT ~Estrogen is most effective for vaso motor symptoms ~improve mood in early menopause ~ improve sexual function ~ improve vaginal dryness and dyspareunia ~ help relief bladder symptoms and reduce risk of recurrent UTI Other effects • Protective effect against connective tissue loss • Bone protection • Mirena can be used to reduce progesterone effects Long term effects of HRT • Preserve bone density • Significant reduction in heart disease • Improvement in cognition • Reduction in long term risk of Alzheimer's and all cause dementia What about breast cancer? • WHI... Small increase in breast cancer risk. 1 extra case/1000 women / year. • In same WHI Estrogen alone significant decrease in breast cancer risk • Recent critique of both WHI and MWS revealed flaws which limit the ability of the trials to establish causation Other cancers • Conflicting evidence on ovarian cancer risk • Reduced risk for endometrial on continuous combined preparations. • Reduce risk of colorectal cancer Summary practice points • Individualised decision for each woman • Dosage and duration individualised • Annual evaluation of pros and cons • With time increased sophistication of hormonal preparations will reduce side effects Key recommendations • Main indication is relief of vaso motor symptoms • Duration should not be subject to arbitrary limits • Routine advise on diet and life style • Phytoestrogens offer some benefits on symptoms and on skeletal and cardiovascular systems • Don't start HRT 10 years after menopause Issues • MPA is associated with higher risk of breast cancer than other progestogens ( American association of cancer research) • Moderate increased risk of VTE may only relate to oral and not transdermal preparations (RCOG) Does HRT cause breast cancer • Recent decrease in incidence of breast cancer • The decline occurred immediately as HRT use declined • No duration lag to support the association • The evidence neither supports nor refutes the theory of possible causation • The associated risk of breast cancer is lower than that associated with obesity and alcohol and later reproduction Benefits Re examining the evidence • Reduction in cardiovascular problems • Fewer risks than initially reported • Neuroprotective with preservation of cognitive ability and verbal memory Parkinson disease • Younger age of onset in males • Oestrogen has direct effect on dopaminergic functioning • PD more common in women after surgical menopause • May be protective from PD or has ameliorative effects on symptoms Reviewing the evidence Dec 2014 • HRT is the most effective treatment for menopausal symptoms • In particular for younger women at the onset of menopause • Hot flushes and night sweats affect 70% of women for up to 5 yrs • 10% may continue for many years The evidence • Symptoms vary. In some can be debilitating and can affect quality of life • HRT is the treatment for the menopause. • WHI 2003 reported increased risk of breast cancer, VTE and stroke • The re-analysis of the Women Health Initiative study in 2007 demonstrated that giving HRT for up to 10 years had fewer risks! And reduction in cardiovascular problems. The evidence • The Million women study 2001 suggested increased risk of breast cancer • But failed to address short use to relief symptoms • Women can gain the advantage and tailor treatment to reduce risk Conclusion • Women live long beyond the age of menopause • Future….Improved formula with better long term benefits and reduced risks • Quality of life