EDUCATING PATIENTS ABOUT THE BENEFITS AND DRAWBACKS OF HORMONE REPLACEMENT THERAPY

Hormone replacement therapy (HRT) influences many aspects of health: c limacteric symptoms, osteoporosis, cardiovascular disease, breast and endometrial cancer, thrombosis and emboli, and Alzheimer's disease. A decision to use HRT may depend on a woman's individual views of the me nopausal transition, the postmenopause and its consequences. It is the refore useful that the health provider inquires about and discusses th ese issues in a cultural and family context. Health providers and pati ents should be thoroughly informed about the symptoms associated with hormonal deprivation, the associated risks of osteoporosis and cardiov ascular disease, and the potential of HRT to prevent these afflictions . Recent studies suggest that HRT might be particularly beneficial in women who have an increased risk for cardiovascular disease (because o f left ventricular hypertrophy, diabetes mellitus, hypertension or hyp ercholesterolaemia, or because they smoke) or osteoporosis. In women w ho are undecided about HRT, a low bone mineral density measurement mig ht help convince them to start using, or to continue using, HRT, There is also a need to discuss with the patient the effect of HRT on cance r risk. In most instances, women can be reassured about the risk of en dometrial cancer. The risk of breast cancer should be carefully consid ered and discussed with each patient before beginning HRT, In most cas es, HRT should not be withheld because of fears about breast cancer, b ecause the protective effects of HRT against cardiovascular disease an d osteoporosis outweigh the possible increased risk of breast cancer. When HRT is prescribed, individual regimens should be discussed with t he patient, who must be warned of the possible adverse effects. In old er women, HRT can be started at half the normal dosage and tolerabilit y assessed before increasing the dosage further.