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Pharmacy Links

MENOPAUSE: WHO USES HRT?

21st April 2009

Those on HRT are mainly women seeking help to reduce their menopause-related symptoms. In some cases the menopause has occurred naturally. In others menopause has been brought on by removal of or damage to the ovaries during surgery, chemotherapy or radiotherapy (see chapter i). The main user groups other than women with generalised menopausal symptoms are those who are at high risk of fractures and heart disease, and those already experiencing these health problems.

A study of Massachusetts women aged forty-five to fifty-five found that, of those on HRT after natural menopause, ewer than one-third continued the treatment for more than two years. Among those who had a hysterectomy, nearly two-thirds stayed on hormones for more than two years. Among women in the natural menopause group, those on hormones were different in some important ways from those not on it. Before they started treatment, these women were more likely to have reported hot flushes or menstrual problems than women who did not embark on hormone therapy. They were also more likely to regard their health as poor and to use health services. These women were better educated, too, and were more likely to have used oral contraceptives in the past.

Prescribing HRT for women who do not have clearly defined symptoms and are not at high risk of postmenopausal fractures or heart disease is quite a controversial matter. Fuelling the controversy are some medical specialists who advocate HRT for most women ‘from menopause to grave’. Supporters of this approach tend to equate menopause with ‘hormone deficiency’ or ‘ovarian failure’, often giving the impression that menopause is a time of dramatic and irreversible shutdown of sex hormone production: the start of a downhill road along which women become crumbling shadows of their former selves. This is a ridiculous generalisation, as the variability in sex hormone production after menopause is vast.

Studies of Australian women aged forty-five to fifty-five indicate that about one in two who have had their ovaries removed at the time of hysterectomy are on HRT, as also are one in three who have had a hysterectomy without removal of their ovaries, and about one in six who have had a natural menopause. In a comparable group of US women, the rate was about the same in the surgical menopause group and significantly lower in the natural menopause group. Rates seem to vary widely across Western Europe, but there are no comparable studies by which to assess this.