The lack of knowledge about its side effects and complications, particularly in the endometrium, caused consequences that limited the use of HRT. The controversial history of HRT revolves around the story of a potent pathogenetic therapy for all post-menopausal disorders. Its effects on symptoms are and were immediately visible, and initially caused a rapid increase in estrogen use. The subsequent association with progestin allowed the widespread use of hormone therapy, with favorable consequences in many aspects of women's health.
Unfortunately, the increase in the use of HRT and its consolidation were abruptly interrupted with the publication of the WHI trial, which was not properly designed, evaluated or reported. The damage caused was enormous and basically left many symptomatic women without effective treatment, even though the epidemiological data were not strong enough to document obvious harm to women's health. Although most of the evidence obtained was based solely on oral conjugated estrogens with or without medroxyprogesterone acetate, subsequent studies and analyses have consolidated the view that HRT is very beneficial when administered to symptomatic women within 10 years of the onset of menopause or to symptomatic women under 60 years of age. However, the damage persists and hormone replacement therapy continues to be underused around the world, which is not justified.
The new analysis is based on two decades of follow-up data from the Women's Health Initiative study, which followed thousands of women receiving hormone replacement therapy. The study was discontinued when it was discovered that women taking Prempro, which is a combination of estrogen and progestogen, had a higher risk of breast cancer and stroke. Doctors continue to prescribe hormone therapy pills for menopause in higher doses, despite clinical evidence that low doses and skin patches work just as well and pose fewer health risks. According to the WHI, women who received hormone replacement therapy had significantly less osteoporosis and colorectal cancer. But they also reported an apparently higher risk of diseases such as breast cancer and stroke.
The authors came to the general conclusion that hormone therapy presents more risks than benefits and should not be used to prevent diseases. The investigation was suspended for security reasons. New prescribing guidelines state that doctors should prescribe hormone replacement therapy only as a last resort and only in the smallest effective amount for the shortest possible time. As expected, prescriptions for oral hormonal hormone therapy plummeted rapidly. For some years now, prescription guidelines have agreed that hormonal hormone therapy should not be used to prevent the disease in the long term, but in the short term to alleviate menopausal symptoms.
The NICE guidelines reiterate this advice. Some doctors, for example, have been reluctant to continue prescribing hormone therapy beyond the five years described as “short-term” in the prescribing guidelines, even when a woman continues to have severe menopausal symptoms and, knowing the potential risks, wishes to continue taking replacement therapy hormonal. Stafford and her colleagues also expected that, for women who needed treatment for menopausal symptoms, doctors would start prescribing hormone therapy during or just after menopause more often. Doctors across the country continue to prescribe hormone therapy pills for menopause at higher doses, despite clinical evidence that low doses and skin patches work just as well and pose fewer health risks.
Most doctors and scientists agree that HRT, and specifically the estrogens in HRT, are good for menopausal symptoms. Following these announcements, regulatory authorities in the United Kingdom issued an urgent safety restriction in relation to hormone therapy, recommending that doctors prescribe the lowest effective dose to alleviate symptoms, use it only as second-line treatment to prevent osteoporosis and not use it in asymptomatic postmenopausal women. I just received this heartbreaking letter from a 46-year-old woman to whom three women's health doctors have refused to prescribe hormone therapy. Carothers says the conversation with your doctor could also take place when you're 40 or if you're ready to talk about stopping using hormonal contraception because of a tubal ligation or other procedure. The negative results of the study received wide publicity, causing panic among some users and new guidelines for doctors about prescribing hormone replacement therapy.
Based on these findings and the resulting publicity, millions of women discontinued hormone therapy and doctors stopped to prescribe it. The publication of the WHI results on heart disease and the MWS results on breast cancer in 2002 and 2003 caused a marked and rapid drop in the worldwide prescription of hormonal hormonal therapy. However, they sometimes think that not prescribing hormone replacement therapy is the right decision, due to outdated research. Fear and sensationalism triumphed over science, and for doctors and patients alike, hormone replacement therapy became a source of anxiety.
Here are some of the uninformed (and frankly ridiculous) reasons I've seen why doctors lately refuse to prescribe hormone therapy.
