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paul hancock asked...

My wife has been diagnosed premenopausal

My wife has been diagnosed premenopausal at the age of 40. After having seen two seperate GPs, there appears to be some professional disagreement regarding HRT. Basically one is for as the long term benefit of avoiding osteoporosis is obvious, whereas the other says that a woman who still has periods i.e produces oestrogen would see no benefit.

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The answer

I don’t think it’s so much disagreement as slightly different emphasis. There has been much concern about a possible link between HRT and an increased risk of breast cancer since a major study 10 years ago. However, doubt has been cast on this study and in any case there is no evidence of a link if HRT is taken for under 5 years. What’s more, there is no evidence that taking HRT increases your risk of breast cancer under the age of 50. You are at higher risk of osteoporosis if you go through a premature menopause before the age of 40 and possibly before the age of 45.

Most doctors advocate HRT until the age of 50 for women who have gone through premature menopause, to reduce the risk of osteoporosis in later life. However, the question is whether HRT should be offered when you’re pre-menopausal or ‘peri-menopausal’ (in the years leading up to the menopause) rather than after the menopause.

Technically, a diagnosis of menopause is made a year after you have your last period. However, many women get menopausal symptoms, such as hot flushes, before their periods stop. If your wife has had a blood test which shows low oestrogen levels she may well benefit from HRT. If she has had a blood test which shows normal oestrogen levels she’s less likely to benefit in terms of her bones. If her ‘pre-menopause’ was diagnosed on the basis of her symptoms or other blood tests called FSH and LH but not oestrogen levels, getting her oestrogen levels checked may help her decide when to start HRT.


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