Archive for May, 2012

Hormone Replacement Therapy : a dilemma

There are times when doctors are left staring into space wondering if they have been doing the wrong thing for years.

Hormone Replacement Therapy (HRT), for treatment of menopausal symptoms and the prevention of osteoporosis, has had its critics. And rightly so, because like most medications that have been prescribed to large groups of people often indiscriminately, safety issues emerged. A couple of decades ago it was almost becoming a belief that women over a certain age were neglecting themselves if they did not succumb to the pressures put upon them to take HRT in some form or another. This way of practicing medicine is surely wrong. While acknowledging the importance of sound, well conducted research and the usefulness of guidelines resulting from that research, at the end of the day treatment and prevention, in most circumstances, needs to be tailored to the individual.

The main risk that raised safety concerns re the use of HRT was a serious one – breast cancer.

In 2009, in England, the National Institute for Health and Clinical Excellence gave this “do not do” recommendation regarding HRT.

“Do not offer hormone replacement therapy (HRT) (including oestrogen/progestogen combination) routinely to women with menopausal symptoms and a history of breast cancer. HRT may, in exceptional cases, be offered to women with severe menopausal symptoms and with whom the associated risks have been discussed.”

Now the International Menopausal Society are challenging the massive decrease in prescribing HRT following the work relating it to breast cancer, and they are calling for are calling for a rethink that involves considering each patient as an individual.

Behind the Headlines reviews what the papers were saying about this report.



Their conclusion:

So, is HRT safe?

Like any drug or treatment, HRT is associated with both risks and benefits. However, according to NICE in 2009, the overall balance of benefits and side effects suggests that HRT is acceptably safe and beneficial enough to justify its use for certain women experiencing severe problems during menopause. This is not to say it is risk-free or suitable for the majority of women, but it does have justified uses.

In their report, the authors stated that the International Menopause Society recommends individualised treatment, with age being taken into account as a safety issue. HRT shows the most benefits for women with symptoms who start HRT within a few years of menopause, and therefore as women get older the potential risks of HRT may outweigh the diminishing benefit offered.

The authors of one review concluded: “While HRT is certainly not appropriate for every woman, it may be for those with symptoms or other indications. In that setting, with initiation near menopause, the weight of evidence supports benefits over risks”.

Doctors would assess whether or not HRT was an appropriate treatment on a case-by-case basis. They would take into account factors such as the severity of a woman’s symptoms and whether she has a history of breast cancer (certain types of breast tumour can be encouraged by female hormones).

The findings of this new research do not in themselves suggest that HRT should be offered more widely, but they certainly raise some interesting points over the need for a clear, evidence-based approach to assessing HRT and also in the way perceptions of danger have affected its use. They open the door to further robust research re-evaluating HRT, which needs to be performed and judged in as objective a manner as possible.

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10 tips to beat insomnia

We spend an awful lot of our life sleeping, and tiredness and exhaustion make us feel awful and unable to function. So even without any research at all on the subject of sleep, it seems logical to conclude that sleep is at least as important to our health as food and water.

Here are ten tips on how to help achieve a good nights sleep without resorting to medication.



1. Keep regular hours

2. Create a restful sleeping environment

3. Make sure that your bed is comfortable

4. Exercise regularly

5. Less caffeine

6. Don’t over-indulge

7. Don’t smoke

8. Try to relax before going to bed

9. Write away your worries

10. Don’t worry in bed

If you can’t sleep, don’t lie there worrying about it. Get up and do something you find relaxing until you feel sleepy again, then return to bed.

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