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Hormone Therapy and Doctor's Mistakes

By: Ian Murnaghan BSc (hons), MSc - Updated: 16 Feb 2013 | comments*Discuss
Hormone Replacement Therapy Hrt Doctors

Hormone replacement therapy (HRT) has received a lot of media attention over the last decade. Confusing reports relate primarily to the many different studies over the years.

In some, it shows HRT is helpful for menopause symptoms, while in others, it shows a higher risk of cancer and other diseases. This means it has been difficult for women to understand and make sense of during menopause. Doctors too have been faced with the challenge of prescribing the right treatment based on what seems like constantly changing evidence about the benefits and risks of HRT.

Newer Recommendations

In recent years, however, more solid recommendations have been made and generally agreed by experts when it comes to HRT. Lower dose HRT for shorter periods of time carry fewer risks and comparable effectiveness to higher-dose HRT. Yet despite such recommendations based on current evidence, many doctors still make the mistake of prescribing higher doses of HRT, thus putting women at a significantly higher risk of diseases relating to HRT use during menopause.

Why Use HRT?

When a woman approaches menopause, her ovaries do not produce as much oestrogen as they once did, leading to a number of uncomfortable symptoms. These include hot flushes, problems sleeping and mood swings.

They can be extremely disruptive to a woman’s quality of life, typically leading her to choose treatments to help ease the symptoms. For some women, this treatment is to take HRT, which restores hormonal levels, thus reducing the common symptoms of menopause. In fact, millions of women are treated with HRT.

Dangers of HRT

The controversy of HRT began when a clinical trial approximately ten years ago was stopped early because such significant risks were seen in the participants. These risks include a heightened probability of developing breast cancer and heart disease. At the time, it was surprising because it had been thought that HRT would lower the risk of such diseases rather than raise it.

Media Scare of HRT

After the initial ‘scare’ that was often exaggerated in the media, more reasonable recommendations and guidelines for HRT were established. Lower doses of HRT are known to be highly comparable to higher ones, but with less of a risk in terms of cancer and other diseases. The side-effects are also fewer for such a lower dose of HRT.

Mistakes in HRT Prescribing Behaviours

The problem now, however, is that many doctors do not seem to be aware of the benefits of prescribing a lower dose of HRT compared to a higher one. Although since the recommendations were established, more doctors are prescribing lower doses, this number is not nearly enough according to researchers. Far too many doctors are still prescribing higher dose HRT and seem to be oblivious to the risks involved relative to the benefits of lower dose HRT.

Statistically, it is around two-thirds of women who respond favourably to lower dose HRT. Yet fewer than a third of women are being prescribed a lowered dose of HRT. The hope now is that these statistics will soon change if doctors are properly educated about the risks and benefits of different dosage patterns.

Changing Prescribing Behaviours in Doctors

This new study shows that there is much communications work to be done when it comes to HRT prescribing behaviours. Researchers now want to learn what information doctors have been receiving and whether it is a case of them not being clear on the evidence or if some do not agree with it. The hope is that more women will be prescribed low dose HRT, which can allow them to experience the benefits of this treatment with fewer risks than those that come with high dose HRT.

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