Sally Cockburn May 25, 2012
Digital image: Judy Green
The news that HRT is safe for most women has come 10 years too late for many of us.
OK LADIES, there we have it in black and white: "Australian doctors are being told to reconsider hormone replacement therapy for menopause after a major review found the controversial treatment was safe for most women in their 50s.'' Good-o. But is this really going to flush a decade of scaremongering under the bridge and make us all relax about HRT? Or will this "new" information just get chucked on the ever increasing pile of conflicting media health advice?
Oh, did I say "new"? What bunkum. My memory serves me well: I checked the Fairfax online news archives and it is clear that many people have been questioning these National Institutes of Health Women's Health Initiative findings since they came out. But since 2002 we've seen a myriad of "balanced" articles in the media with an expert who says one thing, and another who contradicts them. Good journalistic "balance" but not so useful as advice. And information overload can lead to reader inertia.
I'm not blaming the media. After all, most of my medical colleagues are too scared to speak out on the topic in case their ''words are twisted" (their paranoia, not mine) or worse; that the statistics pendulum should swing the other way next week and their words might be used against them in court at a later date. So we're all confused. But where does it leave the person seeking answers? Doing nothing, that's where.
Realistically, many women are going to simply shrug this "new" HRT headline off and say, ''Yeah, yeah, probably still best that I do nothing, put up with my lot and bury myself in looking after everyone else".
We're rightly cynical and somewhat immune to the seemingly constant backflips in medical advice being reported in the media. You know: last week's cancer cause is now a cure and next week it will be vice versa.
But in this case, I don't think the underlying message has changed. The default action to do nothing isn't the answer. Oh, I can hear cynics bleating "a few flushes aren't fatal". Sure, but when you are having violent mood swings, joint aches and insomnia that threaten your relationships and/or employment it can be devastating . Yes, I hear you - "many women sail through menopause" - but this does not negate the rights of those who are suffering badly, and they deserve help. In my opinion, the rights of these women have largely been trampled over the last decade and they have the right to be angry. But for the fact that I didn't listen to the scaremongering and am taking HRT, I would be flinging open the window right now, channelling Peter Finch and yelling "I'm as mad as hell and I'm not going to take it any more".
This "news" about HRT being OK for us is 10 years too late for many. We have borne the hormonal burden for our families all our adult lives and now in our 50s we deserve better. How come these researchers took 10 years to reassess their stats? Why didn't the media demand answers sooner? Why were the expert voices of reason drowned out?
Interestingly, if this situation had been reversed - say, a drug claimed to be safe was now discovered not to be - my legal brothers and sisters would have a class action happening before the ink had dried on the newspapers. But what compensation is there for the women who have lost a decade of sleep or worse because someone misinterpreted the risks? I am told a class action doesn't apply here, but an apology would be nice.
So where to from here? Fortunately during the past decade there has been some sensible behaviour in general practice because out here in the real world we treat people, not statistics. Fortunately women who feel comfortable in a partnership with their GP have been able to discuss their own personal risk/benefit ratio for HRT for menopause. If this hasn't happened, then it's time to revisit the topic with your GP. However my advice is to wait for about four weeks so your GP can absorb the advice from our trusted sources and feel comfortable that we know what we are talking about.
Then again, I suspect that like many of my colleagues, the general advice I have been giving for over 10 years hasn't really changed: I believe you don't need HRT if you don't have symptoms and your bone density is OK. But if your symptoms of menopause are interfering with your life to a point where you are having difficulty coping, and the benefits of taking HRT outweigh the risks, then it's worth considering giving it a go.
Of course, the decision is yours. You should have a mammogram and bone density study before starting HRT, and monitor your health while you are on it. You can stop at any time but keep reading, discuss your case with your doctor regularly, and definitely reassess the whole thing after five years. Who knows what the NIH will say in 2017 …
Dr Sally Cockburn is a GP and host of 3AW's Talking Health, which will have experts to answer questionson HRT on Sunday at 6pm.
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