Health Issues is a general health based blog concentrating on multiple health topics.

Strokes and blood clots

Opposed HRT (where both oestrogen and progestogen are used) has a similar effect on the circulatory system and our veins and arteries as does the Pill. It can lead to risks connected with raised blood pressure, migraine, strokes and thrombosis. You must ask yourself: is taking HRT worth the risk?

Heart disease

Second to osteoporosis, heart disease is the reason given to many women for starting HRT because it supposedly decreases the risk of heart disease. In fact the Framingham Study (the best-known long-term study of 670 women on HRT in Framingham, Massachusetts), which reported its findings in the New England Journal of Medicine in 1985, showed that the risk of heart disease actually increased on taking the hormones.”‘ As HRT contains the same combination of hormones as the Pill (with differences in dose and structure), the British Medical Journal m December 1992 stated, ‘Many doctors have been surprised to discover that a hormonal treatment they had learned to avoid in women at risk of cardiovascular disease is now being specifically advised in this situation.’ Yet HRT is currently touted as a preventative measure.

Osteoporosis

One of the other main reasons women take HRT is that they are told that it will protect their bones. Such is the fear of osteoporosis that women have been persuaded that HRT is a prime preventative measure. It is quite extraordinary that women are prepared to take powerful hormones to try to prevent something that may never happen anyway – or that can be avoided in most cases by perfectly benign means such as diet and exercise. It’s even more extraordinary when you consider the full meaning of the research into the impact of HRT on bone health. The Framingham Study showed that only women who had taken oestrogen for at least seven years had significantly higher bone mineral density than women who had not had oestrogen.” Even those who had been on oestrogen therapy for ten years were not protected from fractures. Their bone mineral density declined rapidly as soon as they stopped taking oestrogen. By the time they were seventy-five to eighty years of age – the age at which most fractures happen – their bone mass was only marginally higher than the women of comparable age who had never had oestrogen at all. They had only a trivial advantage.

The conclusion is that for HRT to be effective against osteoporosis, women who start taking it at the menopause must take it for decades. In fact they must take it for the rest of their lives if it is osteoporosis they are worried about. Or perhaps not think about taking it until much later – nearer the time that fractures happen. This is perhaps one sensible option worth exploring -but one which would blow a big hole in the billion-pound market for HRT products which needs to get women on to HRT as soon as possible. Even worse, the Framingham study was based on women taking oestrogen alone, rather than the oestrogen-progestogen combination that is now the most widely used form of HRT. The truth is that we really have no idea whether women taking the combined HRT will get any bone benefits at all. Yet every frightening leaflet you pick up about osteoporosis proclaims the efficacy of HRT while the reality is that very little of any practical relevance has actually been proven. As Dr Bruce Ettinger, an osteoporosis expert, says, ‘It definitely works, but you’re talking about taking hormones for ten years – maybe twenty to thirty years – to prevent a largely asymptomatic, self-limited disease. And what are you offering – the risk of endometrial cancer? Lifelong periods? Endometrial biopsies?’ HRT is certainly not a ‘cure’ for osteoporosis.

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