Safety of HRT

Because of the rapidly changing ideas about the safety and effectiveness of hormone therapy we feel it is important to be sure that you have information about the risks and benefits of hormone therapy before you take the therapy we have discussed.

Bio­identical Hormone Therapy (BHRT)

Bioidentical hormones have the exact same chemical structure with your own hormones. Your BHRT prescription is made in a compounding pharmacy and the dose is adjusted to your needs. As it is not a fixed dose combination, this medication is unlicensed.

BHRT is often prescribed to women during perimenopause (the time from first symptoms to up to several years beyond the last period) and menopause (starting one year after the last period) for symptoms of hot flushes, vaginal dryness, loss of libido, depression, irritability or PMS­ like symptoms, bone loss and osteoporosis or its prevention, and cardiovascular disease. Sometimes, hormone therapy is recommended for PMS, PMDD, postnatal depression, polycystic ovarian syndrome (PCOS), endometriosis or hormonal acne. For men it may be recommended for Andropause or testosterone deficiency. This may
be recommended in addition to nutritional advice or psychological support.

Hormone Replacement Therapy (HRT) is approved by the FDA only for hot flushes and osteoporosis. Using it for other symptoms or problems is considered “off­ label” use, and the burden is on the physician to be sure that there is adequate science to support the use in a given situation.

Potential Benefits

When hormone levels are brought back to “normal” for your age, there is much evidence that your overall health benefits. The risk of osteoporosis and fractures may decrease. Oestrogen therapy is the most effective treatment for hot flushes. There may be other longterm beneficial effects of treatment, such as improved sleep, mood and memory.

Bio­identical hormone therapy may contain one or any combination of the following hormones: oestrogens (oestradiol and oestriol), progesterone, testosterone and dihydroepiandosterone (DHEA). Thyroid hormones (thyroxine and triiodothyronine) may also be prescribed depending on your needs.

Risks

Studies showed that using oestrogen alone had decreased risk of breast cancer but an increased risk of endometrial cancer.

Subsequent studies added synthetic progesterone to HRT, which protected the lining of the womb against endometrial proliferation. It is now thought that the combination of oestrogen and progestins (synthetic progesterone) increases the risk of breast cancer over oestrogen alone.

The risk of breast cancer depends on a number of other lifestyle and genetic factors, such as obesity, alcohol and smoking; please discuss this further with your doctor.

There is no sufficient data to fully quantify the risks associated with bio­identical progesterone, rather than synthetic progestins, although preliminary data from cohort studies so far may suggest less risk.

We monitor our patients regularly and our clinic protocols recommend routine pelvic ultrasound as well as a mammogram/ breast ultrasound and how often these tests are recommended depends on your risk factors and your doctor will advise you accordingly.

Mammography is currently the most accurate method to detect breast cancer. However, Mammography does not detect all breast lumps or breast cancers, and breast ultrasound does not detect all solid masses or breast cancers. A monthly self breast exam as well as an annual breast exam by a qualified health care practitioner is recommended. Note: If you have not had a recent breast exam by your physician or nurse practitioner, we recommend that you do so.

Pelvic ultrasound scans can monitor changes in the uterus (womb) and the ovaries. Ultrasound examinations (scans) are done by building up pictures from the return of sound waves as they bounce back from any resistance they meet. The sound waves can be directed to and bounced back from the surfaces of various structures within the body to form pictures on a television screen.

Bone density scans are often used to diagnose or assess your risk of osteoporosis, a health condition that weakens bones and makes them more likely to break. As well as being quick and painless, a bone density scan is more effective than normal X Rays in identifying low bone density.