A few years into the menopause, you may notice changes in your urinary habits. The pelvic floor becomes weaker and the pelvic organs may begin to slide downward, giving rise to uncomfortable sensation. Osteoporosis is the commonest long term complication of the menopause. As the amount of estrogen decreases, increasing amount of calcium dissolves out of the cortical bone. This process of accelerated bone loss is osteoporosis, and it continues to the end of life. As you age, the “soften” bone becomes prone to fracture. Severe osteoporosis of the spine leads to loss of vertical height and the back becomes hunched. When your long bones are severely osteoporotic, you may have hip or wrist fractures with minimal trauma. For many years, it is known that estrogen is cardio-protective; which is the reason why there are less coronary heart disease and strokes in women before the age of the menopause. When the menopause sets in, your risk for coronary heart disease increases significantly.
If you suffer from the symptoms of going through “the change”, and they are making your life unbearably miserable, the use of estrogen replacement is the most apt treatment. No other medication or plant products measure up to it. Your quality of life improves soon after and you will be in a better position to engage the mid-life. Hormone replacement is also prescribed, albeit less frequently nowadays, to prevent the long term effect of the menopause. This is especially important if you belong to the high risk group who are prone to osteoporosis, coronary heart disease and strokes.
It is wisdom to say that anything and everything when used in excess has undesirable
outcomes. There is no medication that does not come
with a host of potential complications. The science
of medicine determines what possible effect can arise
and what is the risk involved. The art of medicine applies
the data in each individual to use it appropriately
in order to minimize the risk. We are in the position
to advice, but we cannot make the decision for you.
Unfortunately everyone is concern about side effects,
and the bad media publicity does not make it easier
to have an informed understanding.
There is evidence since the 1970s that prolonged use of combined estrogen and progestogen replacement therapy increases the risk of breast cancer by a small amount, estimated at 2 per 10000 per year (after 5 years of use) above the baseline risk. This increase is nullified when estrogen is used on its own. The risk is not high, and it is certainly advisable to have regular breast surveillance if you are using hormone replacement. There is no evidence to suggest that HRT increases the risk of cervical or ovarian cancer. In fact, users of HRT are found to have reduced risk for colorectal cancer.