- Instead of taking progestogen each month, is it safe to take it, say, every three to six months so that I don’t have so many withdrawal bleeds?
Researchers are now looking into this possibility. The available evidence suggests that, in some women taking oral oestrogen each day and progestogen for ten to fourteen days every second month, the endometrium is protected sufficiently for this to be a safe and convenient option. Further research is needed to determine which women are best suited for this approach, however. Women who have a very light monthly bleed or no bleed at all could turn out to be suitable. Until the research under way has been completed, it seems likely that most doctors will continue to prescribe some progestogen each month.
- I am taking oestrogen and progestogen, with five days at the end of each cycle when I don’t have any hormones. Is this approach widely used?
There doesn’t seem to be any justification for this once-popular approach as menopausal symptoms can return during the hormone ‘break’.
- I’ve had a hysterectomy. Is there any reason why I should take progestogen as part of HRT?
It was suggested at one stage that progestogen might protect the breast from cancer development, and this remains controversial. At the 8th Congress of the International Menopause Society in Stockholm in 1993 there was considerable discussion of whether oestrogen or progestogen, or both, stimulate breast cell growth. It may be that less stimulation occurs in women on low-dose oestrogen and progestogen throughout each cycle. It was suggested that even women without ovaries should be on this combination. Research is assessing this. Meanwhile women without a uterus usually receive oestrogen alone. This does not seem to increase breast cancer risk in the short term (less than five years).
- I am fed up with hot flushes and night sweats and am considering HRT, but I have fibroids. Should this affect my decision? HRT can be prescribed to women with fibroids. However, if fibroids are bulging into the cavity of the uterus heavy bleeding may occur, and this will need to be investigated and may need to be treated before HRT is prescribed.
- My vagina is dry and itchy and sex is often painful. I have started using a vaginal cream that contains oestrogen and wonder if I also need a lubricant?
You will find that your oestrogen-containing cream improves lubrication and reduces itchiness within a week or two. Until then, you may want to use a lubricant when having sex.
- Are hysterectomy rates going up?
After peaking in the late 1970s, rates of hysterectomy appear to have stabilised in Australia, with about 25 per cent of women having the procedure by the age of sixty-five. A NSW study found women aged from thirty-five to forty-nine years were most likely to have it, particularly in their late forties. Most of the operations were for benign disease such as endometriosis or fibroids.
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