Low-dose HRT may be better

For most menopausal women, it really is a situation of “damned if you do and damned if you don’t”.


Hormone Replacement Therapy (HRT), once crowned as the wonder drug for most menopausal women, now suffers from a bad reputation after the Women’s Health Initiative under the United States National Health Institutes concluded that the overall adverse effects of HRT far exceed its benefits, and women on HRT are at an added risk of breast cancer and coronary heart disease.

But while some may be able to cope with the menopausal discomfort and complications such as hot flushes, night sweating, insomnia, and osteoporosis as “part of nature’s course” and would not consider asking for medical help, others may not be able to.

However, some health experts feel these women might be suffering needlessly from the symptoms when HRT has proven to improve the quality of life for menopausal and post-menopausal women.
Malaysian Menopause Society (MMS) President, Prof Dr Nik Mohd Nasri Ismail, argued that HRT should not be excluded as part of an overall strategy, such as maintaining a balanced diet, regular exercise, and reduction in cigarette and alcohol intake, to ensure the health of post-menopausal women.

He was talking at the launch of Angeliq, an oral HRT, during the 6th Malaysian Congress on Menopause, organised by the MMS.

"The primary aim of HRT is to improve the physical and psychological well-being of women," said Dr Nik Mohd. "The majority of the women in Malaysia are not advised by their doctors to start HRT."

He says that among Malaysian women, the top fears towards HRT use is breast cancer, uterine cancer, bleeding and weight gain.

Angeliq, a low-dose, oral estrogen-progesterone combination product, has been approved for treating moderate to severe vasomotor symptoms associated with menopause, of which hot flushes are the most common symptom.

It also claims to prevent weight gain due to water retention and lower blood pressure for post-menopausal women with hypertension, in addition to minimising hot flushes by 80 per cent within four weeks.

"It is important for women to be aware of other health risks factors such as raised blood pressure when considering menopause management," said Professor Dr Marco Gambacciani, of the Menopause Research Clinic from the Santa Chiara University Hospital, in Pisa, Italy.

"Women and their medical practitioners need to consider the broad perspective of lifestyle and general health measures within menopause management as we may be seeing a heavier prevalence of heart disease and osteoporosis among menopausal women in the Asia Pacific, particularly as the number of older women in Asia is expected to soar from 107 to 373 million by 2025.

"Women with mood disorders and severe menopausal symptoms could benefit from this safer form of hormonal therapy," said Dr Gambacciani. "But the decision to take hormones and for how long has to be made on a case-by-case basis."

As Malaysia’s population ages, it means a huge proportion of women will be in the market for such remedies.

"By 2020, women over 50 will be 20 per cent of the population," said Dr Nik Mohd, citing good health care as the main reason.

But should women attempt to combat the discomfort by trying to live a healthier life, such as by eating mostly organic food and exercising more often?

"You will have to eat two kilos of soya everyday to get the same benefit as one HRT tablet," said Dr Nik Mohd. "Or half a kilo of tempeh."