WHEN SHOULD I START TAKING HRT, AND HOW LONG SHOULD I STAY ON IT?
If you are at risk of developing osteoporosis you should start within about five years of the menopause for maximum effect, as these are the years of greatest bone loss; catch it then and your risks of a fractured hip or vertebra of the spine are greatly reduced. However, even starting much later will still give some benefit, and there are plenty of women who start after the age of 70 and still gain great benefit. There really is no time at which you are too old to start.
Much more research is needed into the effectiveness of HRT in older women, as most doctors in the UK seem reluctant to prescribe it to a woman over 65. This is a pity, as it can be of great benefit to them. The risk of developing osteoporosis and heart disease is much greater over the age of 65, so this would seem a good time of life to be taking HRT. Obviously, women with a uterus do not like the idea of returning to a monthly bleed, which may be heavy or painful, and they may also experience breast tenderness and leg cramps. An increase in sexuality can be quite disturbing after several years without it. This is balanced against an increased sense of wellbeing, less stiffness in joints and muscles, and more energy. Once again, it is a question of balancing the advantages to you against the disadvantages, and when no-bleed HRT is in general use this may greatly affect how older women feel about it.
How long you stay on HRT will depend on you, your symptoms and your long-term risks. For most women, two years is about average for hot flushes, etc, but if they return when you stop the HRT, then you will probably want to keep it on for a while longer. You may be one of those women who need HRT for five years, or even much longer, to keep flushes at bay.
For relief of vaginal dryness, vaginitis and recurrent vaginal infections, you will probably want to stay on HRT for as long as you choose to remain sexually active. Sex doesn’t have to stop in your fifties! For conditions which simply become worse as the years go by, such as incontinence,
osteoporosis and arterial disease, you may decide to stay on HRT for years, perhaps for the whole of your life. If you don’t like the idea of taking it for so long, it is thought that even five years’ treatment in the years immediately after the menopause will considerably reduce your chances of an osteoporotic fracture.
In the end, you will continue for as long as the benefits to you appear to outweigh the disadvantages or risks. Sadly, the majority of women stop taking HRT after about six months, perhaps because of side-effects, or a return of monthly periods, or because of scare stories in the media. In reality, there is no reason why most women should not be able to remain on it indefinitely. Should you develop conditions such as a coronary thrombosis, blood clotting, gallbladder disease, cancer of the breast or uterus or ovary, fiver or kidney disease, or if you have a big operation like a hip replacement, your doctor will probably advise you to stop taking it. Some doctors, however, feel HRT may safely be continued even in these circumstances, especially if coming off it might reduce your quality of life significantly more than suffering these various other diseases would. As with everything medical, in the end when you start taking HRT, and how long you remain on it, should be a joint decision made between you and your doctor.
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