Sometimes I am faced with such contradictory reports on womens health that I struggle to make sense of it. But I try, so last week you may have seen two different reports relating to HRT that I look at more closely below.
About a million women in Britain take HRT, half the level of past decades after studies found it increased the risk of cancers of the breast and ovaries as well as being implicated in heart disease and strokes. However a new report suggests that overall HRT does not protect the heart as has been previously claimed.
HRT increases stroke risk
This isn’t news, we have known for some time that this occurs, but now The Cochrane Report has found after looking at medical trials involving some 40,000 women that there is an increased risk of strokes and clotting depending on the type of HRT. The most disadvantageous to women are the oral, pill, forms of HRT.
All types of HRT can increase the risk of blood clots such as deep vein thrombosis and stroke, but this particular form has been shown to do so more than the patches or gel forms.
An analysis of gold-standard evidence in The Cochrane Report has concluded that women must weigh the risk of clotting and stroke against benefit from HRT.
The risk of stroke and blood clots is listed in the product information for HRT and experts already advise that women on it should have regular health check-ups, and their need to continue treatment should be re-assessed at least annually. Given that the maximum suggested time on HRT is now 5 years women do need to be vigilant and Dame Dr Shirley Bond – a private GP who has been prescribing bioidentical hormones for many years – has this to say:
“Yet again we are being told the advantages of HRT. My main comment would relate to the quote that an analysis of gold-standard evidence has concluded that we must also weight the risk of clotting and strokes against the relief of menopausal symptoms. As I have said so many times clots and strokes produce serious often permanent damage or kill. Menopausal symptoms do not. When they are affecting life style they can be eased or eradicated with safe supplements or natural progesterone.”
Starting HRT when younger could cut the risk of early death and heart disease
That is according to a comprehensive analysis, but how using artificially high hormone levels could improve a woman’s health does not sit right with me. You use hormones, like any other medication, when you have symptoms that need them. As far as I know it is not possible to avoid menopause – which is what this seems to suggest – but as Dr Bond said above it is possible to naturally help the symptoms and without resorting to HRT in every case.
This recommendation comes from the same study which found that the heart protection factor attributed to HRT was only seen in the youngest women in the study – those younger than 60 when they began taking HRT, or women who had started the treatment relatively soon after reaching the menopause.
Maureen Talbot of the British Heart Foundation said: “This study supports what we already know and indicates a possible increased risk of stroke or formation of a blood clot in some women. It is important that women have a full understanding of the risks and benefits of HRT and should talk this through with their GP.”
My view is that rather than starting HRT early women would be better addressing risk for heart disease through simpler methods such as exercise, weight control and supplements that actually do protect the heart such as bioidentical natural progesterone.