What can HRT be used for?
 The Committee on Safety of Medicines has issued guidance about the safe use of HRT for women aged 50 and over. Although some doctors say the advice is too cautious and the risks of HRT exaggerated, this advice will influence how doctors prescribe HRT for the time being. Research studies are very complex and open to criticism and not all doctors have interpreted the findings in the same way.
HRT can be used for the short-term relief of menopausal symptoms
HRT can be used as a short-term treatment to help women who have menopausal symptoms. These usually last around six months to two years or so, and include symptoms such as hot flushes and night sweats, a dry vagina, disturbed sleep, headaches, poor memory, panic attacks, loss of sex drive and aching joints. Some women have only minor symptoms whilst others can be severely affected. HRT is acknowledged as a beneficial treatment for hot flushes, night sweats and vaginal problems. Some women feel generally much better using HRT. But current safety advice is that HRT should be used for the shortest possible time at the lowest effective dose, with treatment reviewed annually in consultation with a doctor. |
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Bone health
HRT is no longer recommended as the first choice of treatment for the prevention of osteoporosis. HRT does protect against osteoporosis but the protection lasts only as long as women take HRT which in effect means long-term treatment. Though the increased risks are small, the longer that HRT is taken the greater the opportunity for risk.
Dietary and life-style measures are the best way to protect bones (see Preventing Osteoporosis). If treatment is needed other drugs will be tried first before HRT, but if these do not work, HRT may be appropriate. HRT can also be given to prevent osteoporosis in younger women who have been through a premature menopause.
Premature menopause
Women who have a menopause before the age of 45 can take HRT until the age of 50, to counter menopausal symptoms and to prevent osteoporosis. It is thought that taking HRT before 50 does not lead to the increase in risks detailed in HRT Risks.
Preventing Osteoporosis
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To reduce your chances of getting osteoporosis (a condition in which the bones become thin and fragile and break easily), it is best to start preventative measures early in life. But there are also self-help measures which women can take during or after the menopause to maintain bone strength.
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1. | Take regular weight-bearing exercise
The most important factor for bone strength is regular weight bearing exercise. Brisk walks, at least three times weekly help, as do other forms of weight bearing exercise such as dancing, keep fit classes and running. This kind of exercise stimulates bone remodelling. Swimming, cycling and yoga are not weight-bearing. Anyone who cannot move easily can still do beneficial exercises but it would be helpful to speak to a physiotherapist who can suggest appropriate activities.
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2. | Maintain weight
Avoid extremes. Some oestrogen is still made in body fat after the menopause and this useful source can reduce loss of calcium. A history of frequent dieting can also contribute to osteoporosis.
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3. | Eat a balanced calcium-rich diet
Around 700 mg a day of calcium is needed and this is easy to get from a varied diet. Milk and dairy products have high calcium levels. Other calcium containing foods include tinned fish with bones (but the bones need to be eaten) almonds, tofu, also fruit and green leafy vegetables such as broccoli.
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4. | Bone Robbers
Avoid excess alcohol, caffeine and smoking all of which reduce calcium. Too much animal protein (meat and cheese) can affect calcium absorption and too much salt can increase the amount of calcium lost as can phosphoric acid (a preservative used in many canned fizzy drinks).
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5. | DXA Scan (Dual Energy X-Ray Absorptiometry)
Women who have a high risk of developing osteoporosis e.g. past fractures after a minor fall, an early menopause before the age of 45, long-term steroid treatment or have a mother who has had osteoporosis, need to discuss whether it is worth having this type of scan which can help to show the likelihood of future fractures.
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| Treating osteoporosis
HRT is no longer the treatment of first choice for osteoporosis because of safety concerns. Drugs such as calcitonin, bisphosphonates and raloxifene (Evista) a Selective Estrogen Receptor Modulator (SERMs) can be used as first choice treatments for post-menopausal women, (see SERMs). Forsteo (teriparatide) is also now available for post-menopausal women who have severe osteoporosis of the spine. But it is important to note that the National Institute for Clinical Excellence (NICE), the NHS medical watchdog, is reviewing the use of these drugs, which may be restricted.
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