Doctors seek to ease fears over hormone therapy

PUBLISHED : Sunday, 18 August, 2002, 12:00am
UPDATED : Sunday, 18 August, 2002, 12:00am

Women whose health and marital relations have been seriously affected by the menopause should continue hormone replacement therapy (HRT) despite recent cancer-link scares, a leading doctor said yesterday.

Dr Donald Li Kwok-tung, president of the College of Family Physicians, said he had received inquiries from many doctors whose patients feared the therapy put them at higher risk of breast cancer and other conditions.

Patients are concerned over the US National Institute of Health's report last month that linked HRT - which combines oestrogen and progesterone - to an increased risk of breast cancer, heart attack, stroke and blood clots in the lungs.

The trial, involving more than 16,000 women, was ended on July 17 because of the excess health risks attributed to HRT.

According to the research, for every 10,000 women who took the drug for five years, eight more would die of breast cancer every year than in a group of the same size that did not take HRT.

Seven more women would die of heart attacks, eight more of stroke and 18 more of blood clots in the lungs. The highest risks were associated with long-term use of the drug - five years or more. Dr Li said there was still room for HRT for serious menopausal problems if the risk and benefit to patients was carefully balanced.

His remarks came after the president of the Hong Kong College of Community Medicine, Professor Edith Lau Ming-chu, voiced concern over the number of Hong Kong women taking HRT for five years or more.

She estimated half the 10,000 women taking HRT should stop in the light of the research.

However, Dr Li said: 'The basic principle is if the menopausal problems have seriously affected a patient's livelihood and productivity, HRT should be considered.

'Serious mood fluctuations will affect marital relations and even work productivity. HRT can improve one's appearance by giving a smoother skin. This benefit should not be overlooked because this can restore a woman's confidence. This is what we called holistic care.'

Dr Li said doctors should not prescribe HRT to a patient who was - or whose family was - in a high-risk group for breast cancer. Doctors should also regularly review a patient's condition to avoid prolonged use of the therapy.

The College of Family Physicians will soon issue guidelines to all family doctors on administrating HRT.

Dr Li said HRT should no longer be used solely for preventing cardiovascular diseases or osteoporosis because these diseases had treatment alternatives.

Dr Robert Law Chi-lim, spokesman for the Hong Kong College of Obstetricians and Gynaecologists, said the extra risk of HRT in causing breast cancer was minimal. He said another part of the same US study had reassured the safe use of oral oestrogen for up to five years.

Dr Li also warned women could lose confidence at work and in their sex lives if they could not cope with the changes their bodies went through.

Symptoms of menopausal syndrome include mood problems, hot flushes, insomnia, numbness and a feeling of being pinned by the arms and feet. Some patients also suffer physical symptoms that affect their sex lives.

Dr Law said eight to 10 per cent of Hong Kong women at menopausal age of about 50 to 52 suffered from the syndrome.

'Some women lose their libido,' he said. 'In some cases, unfortunately, their husbands react by turning to mistresses on the mainland.'