Hormone Replacement Therapy (HRT)

An informative look at recent Holistic Fitness News

DR KAPLAN'S WEEKLY NEWSLETTER

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To replace or not to replace?

HRT often appears in the popular press. There have been thousands of articles singing its praises as well as an equal amount gravely mistrustful of it. For example, in 2002 there was a trial of a combined form of HRT which they actually cancelled mid-trial because there was some indication of increased breast cancer, cardiovascular accidents (strokes) and heart attacks. However this does not mean that the established forms of HRT are dangerous. It's a controversial medical issue.

This week HRT was right back in the news. The men in white coats in Texas conducted a major trial of an HRT drug called Pembro. Conducted in the classical double-blind format the trial involved 16 000 women and compared the effects of Pembro and placebo. The researchers wanted to know about the effect of the drug (or placebo) on mental well-being, libido, energy levels, sleep patterns and of course, hot flushes. The results were quite a surprise. After one year on the pills, the women taking the active medicine did experience marginally less hot flushes than those taking 'blank tablets'. However they were not happier, did not have more energy, did not sleep better or have a higher sex drive than those taking placebo. This led to health journalists questioning whether the benefits of HRT were 'all in the mind'.

This is a hugely controversial issue and an important one as many women report great benefit from taking various forms of HRT. I think it's useful to compare 'HRT' to other forms of hormone replacement in modern medicine. There are a number of illnesses where replacing a hormone cures severe diseases and even saves lives. A good example is diabetes. The body lacks insulin and the blood sugar becomes dangerously high. It was only in the 1920s that doctors understood this and devised ways of giving diabetics the insulin they lacked. This is perhaps the most graphic demonstration of effective hormone replacement in medicine.

Another example is hypothyroidism, a diagnosis that is often missed in tired and depressed people who are simply short of the hormone, thyroxin. When it is replaced, these patients are amazed at how their quality of life is dramatically improved.

HRT for menopausal women is another story. Menopause cannot be described as a disease, as it is a normal event in the life of most women. Therefore it is not 'automatic' for doctors to replace oestrogen and progesterone in all menopausal women. The pharmaceutical companies sing its praises (naturally) but opinions of GPs and gynaecologists vary about its usage.

My own opinion is that the symptoms suffered at menopause by some women are so severe that the clinical picture is very much like a deficiency disease. Many of these women's lives have been greatly enhanced by HRT prescribed to them by their doctors. Other women have had some mild symptoms and just put up with them. Some women just cruise through the menopause without any discomfort. The problem is compounded by the risk of osteoporosis which can be reduced by taking HRT.

All this means that there are hundreds of thousands of women who do have some menopausal symptoms but are not sure whether to embark on HRT or not. Many of these, very rationally decide to try alternative medicine. If it works then they don't have to make a decision about HRT.

There are many, many alternatives to HRT. Here are some examples: Progesterone cream, Wild yam, Vitamin E, Quercetin, phytoestrogens, Agnus castus, Black cohosh, Ginkgo Biloba etc. etc. The problem is that none of these has better evidence for its use than conventional HRT though all of them have their supporters leading to a lot of 'anecdotal' evidence for their use. Unfortunately, there is a difference between anecdotal evidence and evidence-based medicine.

Homeopathic Tip of the Week

So what about the use of homeopathy for menopausal symptoms? Well, I can't advise you to take any specific homeopathic medicine for this but I can say this. Among homeopaths, the anecdotal evidence for alleviating the symptoms of menopause with homeopathy is very strong. Most homeopaths would think it well worthwhile for menopausal women to have an homeopathic consultation and have a specific homeopathic remedy chosen for their particular symptom picture. It's safe enough and may pay more dividends than trawling through all the evidence for and against HRT.

Dr Kaplan's personal website is: www.drkaplan.co.uk and his practice website is www.140harleystreet.co.uk and he can be contacted on (020) 7487 3416