One of the UK’s most highly respected and internationally recognised gynaecologists is still staggered at the lack of knowledge, especially amongst medical colleagues over the appropriate use of hormone replacement therapy (HRT).
In his articles for inCapitalHealth, Professor John Studd provides the all-essential medical information surrounding the menopause and HRT, and goes on to describe how old, flawed data is still influencing medical decision making. The result is that women are still often being denied a highly valuable and safe treatment.
Many GPs still refuse to prescribe HRT because of outdated advisory statements or merely because it is easier not to bother. Patients can insist, but still may not receive HRT. Their options are to either find another GP or alternatively go to a consultant gynaecologist, although Prof Studd appreciates that finding a new GP is often hard and a gynaecologist in private practice may be expensive.
Professor John Studd says: “In my opinion there should be a menopause clinic in every hospital.”
What about the reported side effects - including breast cancer?
We are still suffering from the hangover that resulted from the badly managed 2002 WHI American study. This study selected and treated an inappropriate patient group who were over the target age range. Furthermore, these patients were treated with the wrong sort of HRT consisting of too high a dose of oestrogen and combined with continuous progestogen. Consequently the results indicated a small but significant increase in heart attacks, stroke and breast cancer in the older patients.
Basing any conclusions on the safety of HRT from this 2002 study is therefore a fundamentally flawed approach. The original investigators from this study have since retracted most of their comments and it is clear that these complications do not appear in women who start HRT before the age of 60. Also it is now known that the probable cause of these reported serious side effects is in the progestogen component and not in the oestrogen.
Prof Studd goes onto explain how it is only logical to treat hormone related depression with replacement hormones rather than anti-depressants. He describes how this group of patients would be far better off seeking the services of a gynaecologist who understands hormone therapy rather than a psychiatrist who has never learned the simple skill of using oestrogens.
Prod Studd also explains the latest hormone treatment options, and how method of delivery, dose and hormone combinations need to be matched to the requirements of the individual patient.
Dr Edin Lakasing, a GP in Chorleywood says; “I entirely agree with Prof Studd. I think we panicked and consequently there has been a dramatic decline in the number of patients on HRT. I very much welcome Professor Studd’s comments and recognise the need to redress this situation. Certainly, HRT is what I would recommend for my own family”.
What is the menopause?
The menopause is a term that merely refers to the cessation of periods. For most women this occurs around the age of 51. During the five or ten years around the time of the menopause is when the worst of the symptoms occur. This is known as the ‘transition’ years leading up to the cessation of periods. After the transition years there are then often problems of vaginal atrophy, painful sexual intercourse (dyspareunia) and, of course, loss of bone tissue (osteoporosis).