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Pharmacy Links

WHAT DO YOU KNOW ABOUT HRT?

April 21, 2009

- I understand that endometriosis becomes less of a problem after menopause without any treatment. Does HRT make a difference? Endometriosis present at the time of menopause usually disappears after it. In exceptional cases, adhesions caused by endometriosis may continue to cause problems. If oestrogen is given from the time of menopause, there is a theoretical risk of stimulating the endometriosis, but in practice this rarely occurs. Taking oestrogen and progestogen together every day is likely to be less stimulatory than taking cyclical progestogen (for ten to fourteen days of each cycle).

- I have developed patches of discoloured skin since using oestrogen. Is this normal? Will it go away when I come off hormone therapy?

Many women on oestrogen (in contraceptive pill or HRT form) are dismayed to find that patches of coloured pigment appear on their skin after they have spent time in the sun. This is called chloasma, and is caused by deposits of melanin in the skin. In a small proportion of women, oestrogen seems to stimulate chloasma development. The effect will usually fade when you stop taking oestrogen, but this depends on how much exposure you have to the sun. Always use a sunblock: your doctor or pharmacist may suggest an anti-chloasma type.

- Are lumpy breasts a reason not to take oestrogen?

No . . . but whether you use oestrogen or not, it is important to examine your breasts regularly, have your doctor check them over too (at least annually), have regular mammograms and avoid smoking.

- I have had breast cancer. Is there any form of therapy, including HRT, that might help to control the severe flushes I am having? HRT is sometimes considered for women who’ve had breast cancer, particularly if quality of life is the priority and nothing else works to reduce flushes. In these cases, Provera or low doses of natural oestrogens (and daily progestogen if you have a uterus) are likely to be chosen. If your breast surgeon and oncologist feel you should not use HRT, you might like to try regular exercise, evening primrose oil or pressed linseed oil, vitamin E, relaxation and meditation to control your flushes. The prescription medication clonidine may also be helpful.

- Since starting on Estigyn eleven years ago I have developed benign cysts in one breast. Is it possible that HRT caused this problem? Should I change my therapy or come off HRT altogether?

There is no evidence that oestrogen, even the synthetic form of oestrogen you are on, causes breast cysts. However, oestrogen may stimulate the growth of existing breast abnormalities like cysts or fibroadenomas, causing them to become larger and more obvious. You should certainly consider changing the type of oestrogen you use. Estigyn is a powerful synthetic oestrogen and, as we explained in chapter 2, it is more likely to produce side effects than a natural oestrogen formulation. There is no justification for you to come off HRT in the circumstances you describe.

- The reason I am taking oestrogen is to make sure that my bone strength is maintained. How can I be certain that the dosage of oestrogen is high enough?

The only reliable way is to have two bone density scans twelve to eighteen months apart. This will indicate whether your bone density has been maintained or has deteriorated while you have been on HRT. If the density has fallen, your dose of oestrogen should be increased if there are no medical reasons against this.