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MENOPAUSE AND HORMONE REPLACEMENT THERAPY (HRT): REASONS FOR NOT TAKING HRT

Absolute contraindications to HRT are few, once it has been established that there is no undiagnosed vaginal bleeding and that the patient is not pregnant. As to existing breast or endometrial cancer, there is no conclusive evidence that oestrogens produce worsening of the conditions. HRT can greatly improve the quality of life of cancer sufferers, whose life expectancy may not be very great and whose menopausal symptoms may be excessive

Relative contraindications require careful evaluation before HRT is used, but in many circumstances therapy is both possible and safe.

Specific disorders include the following:

diabetes may require re-stabilisation;

benign breast disease would require careful monitoring, but the use of HRT need not be ruled out;

otosclerosis, an unusual and possibly hereditary condition which produces hardening and fixation of the small bones in the middle ear, may be made worse with HRT according to some reports;

gall bladder disease can be adversely affected by oestrogen due to changes in bile composition and the greater risk of gall stones;

endometriosis may become worse as a result of the reactivation of the displaced endometrial tissues which oestrogen will bring about;

fibroids, which are oestrogen-dependent, may increase in size but can be monitored by pelvic examination and ultrasonography.

Varicose veins do not rule out HRT provided that they are not acutely inflamed (phlebitis). Previous endometrial hyperplasia should not conclusively preclude HRT provided that adequate progestogen is used (opposed therapy) and there is no previous history of endometrial carcinoma. Liver disease may rule out HRT, depending upon the cause and severity of the condition. However, if the uterus has been removed and the oestrogen (only) is not given by mouth - therefore bypasses the liver — HRT may be possible with careful monitoring.

There appears to be no contraindication for the use of oestrogen in patients with hypertension which is being controlled, or where there is a previous history of deep-vein thrombosis, provided that it occurred as a side effect to some other medical condition unrelated to blood disease or hormone abnormalities, or previous contraceptive usage. However, non-oral oestrogens are recommended in both cases, so that the liver is bypassed and fewer metabolic changes are incurred. The administration of HRT in such instances does none the less require very careful consideration on an individual basis, and continuous close medical monitoring. Recent deep-vein thrombosis or lung embolus would both normally preclude HRT The extent and severity of the condition needs careful consideration and a final decision should be made according to the severity of the menopausal symptoms.

Finally, smoking is not a contraindication for taking HRT, but smokers are at increased risk of developing heart and circulation problems, as well as throat and lung cancer. Also, smoking accelerates the destruction of oestrogen, therefore HRT is less effective in heavy smokers. It is very important for the patient to stop smoking as the hormone changes which occur around the menopause increase the risk of many diseases.

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Women’s health




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