Why you should take HRT

Everyone knows from the media and unfortunately, faulty WHI study on the risks of HRT. The trouble is that the study was flawed in that it was done on an old age group of women who had started HRT after 60 years. Most studies since then have showed that firstly the lefetime risk of breast cancer is less than 1% which is miniscule. The risk of heart problems is also not increased as previously thought but is in fact decreased with HRT.

There are alot of benefits of HRT and women today are shying away from using it and suffering because of the 2002 WHI study and the subsequent sensationalism in the press. HRT will stop any hot flushes, depression, anxiety, prevent disc degeneration and therefore shortening of the spine and height, prevent osteoporosis or softening of the bones and therefore fractures, prevent heart problems such as heart attacks, strokes, prevent loss of libido, prevent dryness of the vagina and painful intercourse, prevent infections of the vagina, prevent loss of skin elasticity as with menopause there is a loss of collagen and that causes the skin to sag, general well being and mood elevation. So you can see that there are alot of benefits, and with the availability of bioidentical hormones now there is no reason why women should shy away from hormones. Indeed I see an increasing number of knowledgeable women in my clinic who are now experiencing the benefits of hormones.

Short menstrual cycles

This would be defined as cycles of less than 26 days. In most cases, there is a deficiency of the female hormone oestrogen. Droopy breasts, depression, irritability in the second half of the cycle will indicate that this is the most likely cause. However if the breasts are painful and swollen in the second half of the cycle then the short cycles are related to a progesterone deficiciency.
A blood test should be done to determine the cause and to make sure that there are no other deficiciencies such as thyroid hormone which will cause the ovaries to malfunction.Treatment would be with bioidentical hormones, the timing and dosage should be adjusted according to the problem.

Hormonal treatment of endometriosis

In endometriosis, typically the mucous membrane which is present on the womb lining develops in unexpected places such as the ovaries, colon or outer surface of the womb. It is related to a deficiency of the female hormone progesterone which is responsible for keeping the endometrial growth at normal levels. As a result there is excessive growth of the womb lining and allows growth in those areas described.

Thyroid and cortisol deficiencies may also cause progesterone deficiency, and will need to be corrected at the same time. Treatment is with progesterone ( the type of progesterone used depends on the severity of the endometriosis) Magnesium deficiency should also be corrected and this will allow relaxation of the womb muscles. Avoid all milk products, sugar and food allergens which may irritate the colon and allow growth of endometriosis. In many cases, treatment with progesterones may be insufficient and strong drugs such as danazol, lucrin have to be used.

Endometriosis starts at a young age and very often the symptoms of painful periods are passed off as just part of growing up, some will just bear with the pain for many years thinking that it is normal and will disappear after giving birth. Eventually many of my patients present in their late 30s with persistent pain and or infertility and I will find extensive and severe endometriosis with big ovarian cysts and damage to the surrounding organs. They inevitably need surgery followed by medical treatment to prevent a recurrence. The take home message would be to have a gynaecological checkup as early as possible especially if painful periods are present. Regular checkups will ensure that the condition is picked up at an early stage and treated appropriately.

Ovarian Cyst

Ovarian cysts are so common that I see almost 3-5/ week in my practice. Very often they have little or no symptoms and are found routinely at the yearly gynaecological check-up. The most common are the functional cysts which are related to the menstrual cycle. These cysts are due to an imbalance of the bodies hormones and they will often correct themselves or can be treated simply by balancing the hormones. Pathological cysts on the other hand are abnormal and will not disappear with medical treatment. They will need surgery as they are sometimes cancerous. The cysts may be filled with fluid or blood. Some are present from birth and grow to a size that can eventually be detected by ultrasound scanning. They are filled with hair, teeth, bone and sebum!. Symptoms may include painful periods, heavy or irregular periods, painful sexual intercourse and abdominal bloatedness and pain.

Ultrasound scan, blood hormonal tests and ovarian cancer screens are some of the tests done before deciding on whether surgery is needed. Unless a cancer is suspected, most ovarian cysts can be removed by key hole surgery.

Fibrocystic disease of the breasts

This very common condition is characterised by painful lumps in the breast. There are both solid and cystic lesions seen when an ultrasound scan is performed. They are usually multiple in nature. Typically the patient will experience swollen and painful breasts before and sometimes during her period. This condition should be distinguished from a fibroadenoma which is a single solid lump. Whatever the nature of the lesion it is always advisable to have a biopsy ( surgical removal) to exclude a cancer even though the mammogram or ultrasound scan shows that it is likely to be benign. I had a patient recently who had a 7 cm lump in her breast. She did not go to see a doctor out of fear and had left the lump to fester for many years. The scan showed that it was likely to be benign but at removal there was a focus of cancer. Breast cancer is the most common cancer in women today, and every woman should have a mammogram at least once in 2 years after 40 years of age.

Having confirmed that the fibrocystic disease is of a benign nature, a hormone profile done will often show an oestrogen predominance and low progesterone ( hormone levels). Prevention of recurrence and control of the disease is possible by balancing the hormone levels. One should also reduce salt intake, and consume less soy products. Evening primrose oil will also help reduce the effect of oestrogen on the breasts.

Breast and Ovarian Cancer link

You may wonder why your gynaecologists asks you if you have a family history of breast or ovarian cancer during your routine check-up. There is in fact a hereditary element in women with certain breast cancers. These women will carry an abnormal BRCA1 or BRCA2 gene. This is more likely so if she develops breast cancer at a young age. The abnormal gene can be tested for if there is a history of breast or ovarian cancer in the family. If the defective gene is found there is a 60% chance of developing breast cancer and a 55% chance of ovarian cancer. Some women will, in such a case,  opt for elective removal of their breasts and ovaries, as in my patient. She did the test as there was a strong family history of breast cancer. The test came back positive test for BRCA1 and she decided that she didnt want to take the risk and so had a bilateral mastectomy. I then performed a video laparoscopic (key-hole) removal of both her ovaries. Of course this will bring about a menopausal state. However I discussed this with her beforehand and she decided that she would rather take HRT for life then risk an ovarian cancer. Women who develop breast cancer should do the BRCA1 & 2 gene and if positive should consider having their ovaries removed as well.

Tired and Moody

The other day I had a patient who presented to me with vague symptoms of mental tiredness, lack of energy, mood swings and increasing weight gain. She was of course perimenopausal. So the obvious cause and treatment would be with some form of HRT. So I started her on oestrogen and progesterone. The symptoms didnt get better and she came back pleading with me to help her do something. She was already on Prozac for depression. Of course it would have been easy to have dismissed her symptoms as something cerebral. However, I gave it a shot and gave her some chelated magnesium, acetyl carnitine. Low and behold, the effect was instantaneous, she was feeling better the next day and she is ever greatful to me for helping her. Who would have guessed that it was just a deficiency in minerals!