COULD THE PAIENT BE OFFERED A 'TRIAL OF THERAPY'?

Yes, We believe that this is a greatly undervalued and underused option. It is most unlikely that any patient is going to suffer serious long-term consequences from a therapeutic trial lasting for three months. Because maximum benefits of estrogens in the relief of hot flushes may not be achieved for three months, duration of treatments shorter than this are insufficient if vasomotor disturbances are the principal symptoms.

WHAT CONSTITUTES HRT?

Most women receive estrogen and progesterone. The amount of each hormone needed to prevent low estrogen symptoms varies from person to person. Changes in the dose may be needed.

HOW LONG DOES HRT LAST?

Treatment may last a number of years, even decades.

WHAT ARE THE DIFFERENT FORMS OF HRT?

HRT is most often prescribed in the form of pills. All types of estrogen therapy will give relief if an adequate plasma estrogen concentration is obtained. At times estrogen is given through a patch placed on the skin. Estrogen creams used in the vagina can treat dryness but do not work against other symptoms. Hormone implants are increasingly used. Vaginal injections and suppositories are also being studied.

IF ONE IS ON HRT, ANY FOLLOW-UP INVESTIGATIONS?

If one has any unexpected vaginal bleeding, must contact doctor immediately.
Follows up visits generally include blood pressure check, breast and pelvic exams, a Pap smear and a mammogram. Endometrial biopsy may also be done.

Most of the hormones used are natural as opposed to synthetic ones used in contraceptive pills. Estrogens are the principal hormones used in HRT. Women who have had hysterectomy do not usually need any other hormones; however those with an intact, healthy uterus must take an additional short course of progesterone tablets each month. This causes the lining of the womb to be shed after each course (a withdrawal bleed) and helps protect against any cancer developing in the womb.

ANY CONTARDICTIONS TO HRT?

HRT can not be taken by patient suffering from:

• Cancer of breast
• Cancer of uterus
• High blood pressure
• H/o of heart disease, stroke or blood clots
• Severe varicose veins