Eulalee ThompsonSOME WOMEN are afraid to take the hormone replacement therapies at menopause because of an ongoing controversy linking the hormone, oestrogen, to the development of breast cancer. However, family doctor, Dr. Venice Bernard-Wright said more than 30 studies have so far been done and none of them has produced clear evidence that oestrogen causes breast cancer.
"What is known is that some cancers are oestrogen-receptor positive and if oestrogen is given to these people with an oestrogen-positive tumour, the tumour will increase in size. Also, if given in high doses for a prolonged period, say between 10 to 15 years, there may be a 30 per cent risk for developing breast cancer," she said.
Overall, the studies indicate that the short-term risk is small and Dr. Bernard-Wright said scientists agree that the overall benefits of oestrogen far outweigh the risks especially in the short-term period of five years.
All women will pass through this period of menopause. It is a natural stage of life caused by a decline in the production of two hormones by the ovaries - oestrogen and progesterone. Menopause therefore marks the end of a woman's fertile period and is usually signalled by the final menstrual period. The average age for the onset of menopause is 51, but women who lose their ovaries through surgery, chemotherapy or radiation at whatever age will have induced menopause. The onset of menopause is diagnosed, Dr. Bernard-Wright said, in retrospect, when the woman has not had a menstrual flow for 12 consecutive months.
It is recommended that women replace the decreasing hormones at this time of their lives. Dr. Bernard-Wright said that oestrogen alone can be used as replacement if the woman had lost her uterus through surgery (hysterectomy). This is called oestrogen replacement therapy (ERT). However, the woman must add progesterone to her replacement therapy if her uterus is intact. This is called hormone replacement therapy (HRT). She said that the progesterone protects the lining of the womb from over stimulation and from uterine cancer. All the symptoms of menopause can be prevented or treated with the hormone replacement therapies.
"Some women will sail through menopause without any noticeable changes at all, while in others their lives become disrupted and miserable. The women who do not have any of the obvious symptoms of menopause need to know that they could be at risk for developing more serious and possibly fatal late effects," she warned.
"Unfortunately, cardiovascular disease and osteoporosis can produce no symptoms while they are affecting your body and the first heart attack could be fatal, also the first sign of osteoporosis could be a fragile fracture."
The early symptoms of menopause include hot flashes (flushes), mood swings, anxiety, depression, insomnia, night sweats and irregular menses. Symptoms at the intermediate/middle stage include vaginal thinning and dryness, problems with the bladder (stress and urge incontinence), frequent urinary infections and skin and hair changes. Late symptoms include cardiovascular disease (angina, heart attack and stroke), osteoporosis (brittle bone disease leading to fracture) and mental deterioration (Alzheimer's disease).
Women who should not take ERT/HRT:
pregnant
undiagnosed abnormal vaginal bleeding
active liver disease
breast cancer or any other genital
tract cancers
active or recent thromboembolic disease
(blood clotting conditions)
allergic or idiosyncratic reaction to
oestrogen.
