FOR many women, the choice between dealing with the menopause naturally or using hormone replacement therapy (HRT) with its potential side-effects is becoming an increasingly difficult one to make.

In recent years, major studies have linked HRT to an increased risk of breast cancer and also stroke.

But the current controversy surrounding the use of hormones in medical treatments is not a new phenomenon, according to recent research published in the Journal of Epidemiology and Community Health.

American scientists say that the cancer-causing potential of the sex hormones used in HRT has been common knowledge in the scientific community for well over 70 years.

So how dangerous is HRT, and should women really be worried?

''Hormone replacement therapy slightly increases the risk of breast cancer in the long term,'' explains Dr Annabel Bentley, Assistant Medical Director at BUPA.

''Studies show that about 45 in every 1,000 women aged over 50 who are not using HRT will develop breast cancer over 20 years - and this rises to 47 women per 1,000 after five years of HRT, 51 after 10 years and 57 after 15 years of HRT.''

However, Bentley points out that the increased risk of breast cancer seems to disappear within around five years of stopping HRT.

''It is particularly important for women on HRT to have regular mammograms, and to be 'breast aware' and get medical advice if they notice anything about their breasts that is not normal for them personally,'' she advises.

HRT is definitely not suitable for women who have recently had breast cancer, she stresses.

''HRT also increases the risk of developing a blood clot in a leg vein - deep vein thrombosis (DVT) - which can be life-threatening. There is also an increased risk of gallstones and liver damage in women who have been on HRT for more than five years.

''HRT may have other side-effects, including tender breasts, heavier periods, enlarged fibroids, water retention, weight gain, depression and irritability, but changing the type and dose of progestogen may reduce the side-effects, and this should be discussed with a doctor,'' Bentley adds.

But she stresses that if women are concerned, they shouldn't panic and stop taking the medication - instead they should contact their doctor and discuss the options,

''As with all medications, the decision to use HRT needs to be made on an individual basis, taking into consideration symptoms, personal health, family history, risks, alternative options for treatment and personal preferences.''

HRT EXPLAINED

''Every woman who has periods will go through the menopause at some time in her life, usually between the ages of 42 and 58,'' explains Bentley. ''The experience of the menopause can vary greatly from one woman to another - for some, it is completely trouble-free, but others may have both physical and psychological symptoms. These women can be reassured that the symptoms will ease with time and there is also a wide range of treatment options and support available.''

Bentley says that HRT is designed to replace some of the hormones which are reduced during and after the menopause.

''Women who have had a hysterectomy can take oestrogen alone. Other women, who still have their womb, need to take a combination of oestrogen and progesterone, because taking oestrogen alone increases the risk of cancer in the lining of the womb.''

Bentley says that combined HRT comes in both tablet and patch form, but for an oestrogen-only treatment, tablets, patches, implants and skin gels are available.

''The course of treatment can contain a fixed amount of oestrogen and a progestogen in the same tablet, to be taken every day, known as continuous treatment. Other courses of treatment consist of two or three different pills - usually of different colours - that are taken at different times in a monthly cycle.''

COPING WITH THE CHANGE

Make changes in your diet

Choose low-fat dairy options, and try to lower saturated fats found in meat and substitute them with healthy fats like omega-3 fatty acids from oily fish,

Avoid synthetic fibres

If your bedding is made from synthetic fibres it may be causing you to sweat more - try sleeping under blankets rather than a duvet.

Try complementary therapies

Homeopathy, aromatherapy, acupuncture, massage and reflexology can be of great benefit but make sure that you find a qualified therapist and always buy reputable products.

Dress for comfort

To help combat hot flushes try to dress in removable layers, wear as many natural fibres as possible and avoid very tight fitting clothes such as those made from Lycra.

Take gentle exercise

Gentle exercise such as walking will help your body to release energy and so will often make it easier getting to sleep, as well as helping to prevent osteoporosis.

Relaxation

Rather than fighting a hot flush, it is always better to try and relax while it is happening - try yoga and deep breathing exercises.

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