menstruation > hrt-and-the-menopause

is now good evidence that the survival is better and that fewer oestrogen takers die of breast cancer than non-users. In spite of this, there remains the view, (which I do not subscribe to), that there should be a limit of 10 years. Perhaps this means that oestrogen therapy should be started at about the age of 60 when there will be maximum protection for osteoporosis, maximum cardiac protection with a lesser risk of breast cancer occurring in younger women. It is a reasonable point of view and at least it does reinforce the clear scientific fact that a 60 year old woman should not be neglected by denying her oestrogens because her older bones or even osteoporotic bones respond to oestrogens, even better than the skeleton of the younger postmenopausal woman.

Testosterone

At last, doctors (and patients) are recognising the importance of testosterone. It is not of course a male hormone, as it is present in the normal young female in even higher concentration than oestradiol. But men, hopefully, have more testosterone on board than women. There is a female androgen deficiency syndrome (FADS) which occurs with failing ovaries and certainly after bilateral oophorectomy which manifests itself with loss of energy, loss of libido, tiredness, loss of self-confidence and headaches. These women respond very well to testosterone. Although testosterone is available in tablets, IM injections, patches and gels, these are not licensed for women and the only way in this country to deliver testosterone is by an implant. For convenience, it seems sensible to insert an oestradiol pellet at the same time as testosterone. The benefits of oestradiol and testosterone are particularly apparent in patients after hysterectomy and bilateral salpingo-oophorectomy because a) they need replacement of the missing ovarian androgens and b) HRT should be straightforward as there is no bleeding and no need for the cyclical progestogen with its PMS type side-effects. Our own data of 200 such patients shows a continuation rate of 96% at 5 years and 88% at 10 years. This brings us back to the initial statement about continuation rates because women feel better.

Intranasal Oestradiol

The most recent development has been the appearance of intranasal oestrogen, Aerodiol, which is certainly as effective as oral oestradiol 2mgs or oestradiol patch 50mgs. It has an odd pharmacokinetic picture, as there is a massive peak of oestradiol of 4000 pmol/l at 30 minute (the normal range is 100 to 1400 pmol/l), which is reduced to normal postmenopausal values within 4 hours. I believe this may be a huge advantage, particularly in patients with hormone responsive depression, like postnatal depression, premenstrual depression and climacteric depression. However this hypothesis needs confirmation by clinical studies.

(published with permission in writing from:http://www.studd.co.uk)