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Caps in knowledge: the current upsurge of interest in hrt CAPS IN KNOWLEDGE: THE CURRENT UPSURGE OF INTEREST IN HRT
Menopause seems to have a range of effects on blood clotting factors and cholesterol, depending on how menopause came about. Even before women embark on HRT or bypass it, those who have had a surgical menopause are at greater risk of heart and blood vessel disease than women whose menopause occurred naturally. Many studies of HRT preparations have not taken account of this. Another problem with interpreting HRT studies is their frequent failure to separate dose and hormone type from duration of use. Although this information is sometimes hard to obtain, it is an important consideration because women who have been using oestrogen for a long time started it in an era when higher doses and synthetic formulations were more commonly prescribed. In short, the results of earlier studies of HRT cannot be assumed to apply today without taking account of the formulations and dosages used.
Women on HRT are more likely to be examined by a doctor and to have regular screening tests and monitoring of their general health than those who are not. This might result in a false picture of risks to health posed by HRT (because diseases not picked up in the general female population may be recognised in the HRT group as a result of their seeing doctors regularly and having more investigations). Paradoxically, the HRT group might survive longer, not necessarily because of any benefits conferred by their hormone treatment but because their routine monitoring might result in earlier disease detection, when the chances of successful treatment tend to be better.
The current upsurge of interest in HRT is occurring at a time when heart disease rates are declining and breast cancer rates are increasing in countries like Australia and the US. HRT may be contributing to these trends, but the extent of this contribution is controversial.
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