MsRima Patel, 48, seitiorvice presidertt in a leading pharma company, slated to be the next president of her fl4gship division, had to take pre,.,mature retirement because of her hot-flushes. This embarrassed her no end at important meetings. Ms Patel had been recommended HRTat the time of her hysterectomy (with ovaries too removed) 3 years ago. She/had vehemently refused, HRT because shefelt it was not warranted. .If this is the state of a v.I.P. in a pharma company, what ab.out others?
Ms BhartiMhatre, 52, had a violent bout of sneezing and fractured 3 of her ribs. The reason? She suffered from osteoporosis, one
of tbe. effetts of menopause. Even she bad rejected the offer ofHRT..IJQ.ththese are rea I,., life cases and not afigtrtent of itnaginatipn. Doctors right acrosS India are offerittgHRT, but/our patients, riddled with myths,.rejectHRTwithout even a serious consideration.

What is HRT?
The wonderful hormone Oestrogen (that protects a woman from Hypertension and heart disease), begins to decline with approaching menopause. Sadly, this is the stage when a career woman is at the peak of her career or a housewife is just settling down. to enjoy the fruits of endless labours of bringing up a family. A time, which a woman looks forward to, a time she should relish turns into a dark cavern with effects of menopause. Hormone Replacement Therapy (HRT) is replacing the dwindling levels of this oestrogen.

When is HRT recommended?
HRT is used in all those conditions where there is low oestrogen level in the body. This - may be due to menopause, removal of ovaries a or just before menopause. Menopause is the a most common cause. HRT can prevent a lot of unnecessary suffering not only in the women themselves but also to their families. Menopause is a strain on a woman's family too!
There is no reason why a woman's menopause should prevent her from leading a full and happy life for many years to come.
What are the Advantages of HRT?
Hot flushes occur less often and are less severe. They may stop altogether. Vaginal dryness and pain during sex also reduces considerably Helps reduce bone loss and thus prevent osteoporosis
Protects against heart disease
What are the risks & side-effects?
Cancer of endometrium of. the uterus (women with uterus removed don't have to worry about this). In others, taking progesterone with oestrogen reduces this risk.

HRT provides the most effective way of managing problems associated with the menopause. It gives dramatic relief of symptoms and protection from heart disease, stroke and osteoporosis. But like any medication, HRT is not risk free. The decision to begin treatment depends on a woman's medical history, her symptoms and her risk of bone loss and cardiovascular disease. Some women are less likely to develop problems due to low oestrogen. Others choose not to use hormones.

Some studies show a woman's chances of developing breast cancer is slightly higher than normal in those taking the medication for more than 15 years. Women on HRT should have monthly self breast examination and annual mammograms{An x-ray image of the human breast, used to detect tumors or other abnormalities}. (refer to "My Doctor" July 1996)
About 10% of women have bothersome side-effects including breast tenderness, fluid retention, swelling, mood changes and pelvic cramping. When progesterone is used, one may have vaginal bleeding once every month. Nausea, vomiting abdominal cramps, bloating, jaundice (rarely).
Any follow-up investigations, if one is on HRT?
If one has any unexpected vaginal bleeding, must contact doctor immediately. Follow up visits generally include blood pressure check, breast and pelvic exams, a Pap smear and a mammogram. Endometrial biopsy may also be done. Most of the hormones used are
natural as opposed to synthetic once used in contraceptive pills. Oestrogen are the principal hormones used in HRT. Women which have had hysterectomy{ Surgical removal of part or all of the uterus}do not usually need any other hormones; however those with an intact, healthy uterus, must take an additional short course of progesterone tablets each month. This causes the lining of the womb to be shed after each course (a withdrawal bleed) and helps protect against any cancer developing in the womb.
Any contraindications to HRT?
HRT can not be taken by patient suffering
from:
~ Cancer of breast
~ Cancer of uterus
~ High blood pressure
~ History of heart disease, stroke or blood clots
When, where and how, should HRT be started?
HRT can be started at any age if symptoms are due to oestrogen deficiency. Most hospitals now have HRT clinics. One must go to a gynaecologist with interest and experience in HRT. It can be administered on continuous or cyclical .(3 weeks on; ,1 week off) basis. Continuous administration is started on the first day of menstruation. It can be started anytime if menstruation has stopped. Cyclical adminIstration can be started any time if there has been no bleeding .jn last' 2 months otherwise it has to be started on the 5th day of menstruation. Progesterone is administered for last 10-12 days in women who have their uterus intact. Iri surgeries where there is a chance of blood clot formation or prolonged immobilisation{the activity of protecting something from loss or danger}is required, HRT should be discontinued.