Professor John Studd, DSc, MD, FRCOG
Hormone treatment for the menopause is now much more complex than simply giving oestrogens for hot flushes, sweats and vaginal dryness as there are many new developments to deal with specific problems and to improve acceptability and continuation therapy. There are many reasons why women do not continue with HRT, such as bleeding and fear of breast cancer but perhaps the most important is that they do not feel any better. It therefore seems a waste of time taking hormones to prevent a fractured hip at the age of 80 which may not occur anyway. Firstly, I think that we should avoid using Premarin which contains about 20 equine oestrogens that the human body has never seen before. It is true that it has worked well for about 50 years but we now have a better option, using oestradiol by tablet, patch, cream, implants, intravaginal application and even intranasal application. This is a human oestrogen found in men and women and can be measured by simple assays so that we can have a better understanding of absorption rates and response to treatment.