CAN ANYONE TAKE HORMONE REPLACEMENT THERAPY?
No. If you have certain medical conditions, your doctor may decide that HRT would not be a particularly good idea. If you have certain other conditions, he may refuse to prescribe it for you at all. Whether you can (or should) take HRT depends on your doctor’s assessment of the risks involved, and whether you have ‘relative contraindications’ or ‘absolute contraindications’.
‘Risk’ means the likelihood of a condition developing as a direct result of a particular treatment. In the case of HRT, this usually refers to the risk of cancer, specifically breast cancer.
‘Contraindication’ means that a condition you already have may get worse if you take the treatment. Circumstances in which HRT should not be prescribed (except in very particular cases) are ‘absolute contraindications’; ‘relative contraindications’ refer to situations in which
it can usually be prescribed, but which need careful assessment and monitoring, and only certain types may be advisable (such as the patch, for example, in order to avoid the liver and digestive system).
The generally accepted absolute contraindications, that is circumstances in which HRT should never usually be prescribed, are:
• cancer of the endometrium (lining of the womb)
• breast cancer
• if you are pregnant, or think that you might be
• abnormal vaginal bleeding which has not been investigated and the cause diagnosed
• severe liver disease where the liver is not functioning normally
In addition to these, most doctors would be very reluctant to prescribe HRT if you have or have had:
• a stroke
• a recent heart attack
• a recent thrombosis
• disease of the pancreas
• disease of the gallbladder
• otosclerosis (a rare form of progressive irreversible deafness)
There are, however, some women who suffer from these conditions yet still take HRT. Just occasionally, a doctor will feel that a particular woman is suffering so severely from menopausal symptoms that her whole quality of life is being reduced almost to zero; she may even feel suicidal. In these cases, a doctor may decide, having explained the risks to her, that a low dosage of HRT may be the most suitable treatment. She would obviously need to understand that, for example, a cancerous tumour or a liver condition may get worse, but she does at least have the right to choose, and she will make the decision having been given all the information. For many people, quality of life is more important than quantity, and women who feel this may decide to take
HRT knowing that it may make an existing condition worse, and may even shorten their life. That is their decision. Others will decide that they will not risk making things worse, so they put up with severe menopausal symptoms as the lesser of two evils.
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