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Sunday, 14 August 2011

HRT - Synthetic or Bioidentical

When women reach their 40's,  hormone levels often go out of balance or decrease to the extent that it causes symptoms. Sometimes these may be very non-specific eg loss of energy, difficulty with sleeping etc. When hormone levels have dropped to significant levels ie nearing menopause, the symptoms of flushes, irritability, loss of libido, dryness in the vagina, sagging skin, become more pronounced. The knowledgeable ones will seek treatment early. The problem is that mainstream gynaecologists will be loath to prescibe hormones too early, many women will refuse hormones because of fear of braest cancer, so women suffer and the loss of the bodies natural hormones leads eventually to bone loss, osteoporosis, heart problems, depression as well as non health related problems such as marriage and family problems, problems at work.

The initial studies that showed an increase risk of breast cancer were with synthetic hormones and therefore could be criticised. Bio-identical hormones (BHRT) use hormones that are identical to the bodies natural hormones whereas synthetic hormones (HRT) were similar in chemical structure and in some cases derived from urine. BHRT is usually prescribed in the form of creams. The advantages of BHRT are that they then bypass the liver and are therefore not converted by the liver into other substances. The doses used are also much lower and tailored to the the individual so that hormone levels are raised and maintained usually to that of a woman in her 30s/ 40s. The hormones are not raised to dangerously high levels. BHRT can even be started in women well before their own hormone levels start falling, thereby maintaining their youth.

Friday, 12 August 2011

Multiple fibroids- myomectomy vs hysterectomy

Almost 50% of women who reach 40 years of age will grow fibroids in their uterus. Symptoms that require treatment include heavy or irregular bleeding, urinary symptoms such as frequency or recurrent urinary tract infections, abdominal pain or when the fibroids grow rapidly. Fibroids are fibrous growths which start off as small seedlings and can grow to the size of a football. They may be multiple or singular. My stamina, patiience and eyesight were tested the other day when I had to remove over 30 fibroids from a patients uterus!.( that is not my record!) I say that because it takes time to find and remove all the small seedling fibroids and surgery can last a long time as one looks for needles in a haystack! It is however rewarding because not only does it relieve the patient's symptoms but it also saves her from having a drastic and major operation such as a hysterectomy. If possible this should be the treatment of choice in my opinion, especially if the patient has a healthy sexual life and is not near her menopause. Some gynaecologists may disagree, and recommend hysterectomy as the first line. A hormone profile should also be done and any imbalance corrected to reduce the chances of a recurrence.

                                                         CT scan showing multiple fibroids