Scream for HRT when you get hot flushes – The Straits Times

Even though 80 per cent of women going through menopause will get symptoms such as hot flushes and night sweats, few are confident talking about it. So, what helps?

British Menopause Society chairman Kathy Abernethy said: "Hormone replacement therapy (HRT) is absolutely the best treatment for hot flushes. It can also help sleep disturbance caused by night sweats and is one of the many strategies to keep bones strong ."

Endocrinologist Mark Vanderpump said: "If men got hot flushes, they'd be screaming for HRT."

Other options include the non- hormonal drugs clonidine, venlafaxine and gabapentin, or lifestyle measures such as avoiding spicy foods, alcohol and hot places.

The risk of cancer from HRT is overstated, said Dr Vanderpump.

Cancer Research UK puts it in perspective - if 1,000 women start HRT at the age of 50 and take it for five years, there will be two extra cases of breast cancer and one extra case of ovarian cancer, compared with non-HRT users.

There will also be some extra cases of heart attack and stroke, but the overall negative effects are small. Avoiding HRT could prevent 1,700 cancer cases a year, but staying a healthy weight could prevent 18,000 cancer cases and not smoking would prevent 64,500 in a year.

Author Maryon Stewart advocates a diet rich in plants such as soya that contain oestrogen-like chemicals called phytoestrogens .

But Ms Abernethy said it is not known how much soya is needed to get the same effect as HRT. And if phytoestrogens have similar benefits to synthetic oestrogens in HRT, they may share the risks - an increased chance of blood clots and a possible increase in breast cancer .

Dietary supplements containing isoflavones (the active chemicals in phytoestrogens) and herbal remedies like vitamin E are available over the counter, but there is little evidence of their effectiveness, said the North American Menopause Society.

Eating a Mediterranean-style diet, avoiding obesity and doing regular weight-bearing exercise will help to minimise the risk of heart disease, osteoporosis, depression and osteoarthritis.

Senior cardiac nurse June Davison of the British Heart Foundation said women's risk of heart disease and stroke increases dramatically after menopause.

Oestrogen, which has a protective effect on artery linings, falls and other factors, such as high blood pressure, a higher level of cholesterol and the ageing process kick in.

She said: "Heart disease kills three times as many women as breast cancer does. We don't advise HRT to protect against heart disease. It may increase the risk of blood clots if you are at increased risk and there is some evidence that heart disease is increased in the first year of HRT use."

Women who want to take HRT for other reasons like hot flushes, and are at low risk of heart disease, can be assured that the increased risk will be very low, she added.

Loss of sex drive is common around the time of the menopause. Low mood, tiredness, hormonal changes and relationship problems may all play a part.

Sex can be painful as the fall in oestrogen levels makes the vagina dry and sore, though non-hormonal vaginal moisturisers can restore vaginal moistness.

Dr Vanderpump said women and men in midlife often experience thinning hair, rougher skin and other age-related changes.

But these are more likely to be due to genetics and environmental factors. If you eat a normal, varied diet, there is no reason to think that nutritional supplements will help hair, nails or skin. HRT does not turn the clock back and is not recommended for these factors.

This form of HRT marketed in the private sector claims to offer hormones derived from plants that are chemically closer to the ones that occur naturally in the body.

But the US Food and Drug Administration is clear that they are no safer or more effective than standard HRT.

Dr Vanderpump said that if you find HRT helps symptoms, the prep- aration can be tailored to your needs. Adding low-dose testosterone gel, for instance, may help libido - even though it is licensed only for men.

THE GUARDIAN

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Scream for HRT when you get hot flushes - The Straits Times