Long Term Health Implications
Osteoporosis
Osteoporosis – often known as brittle bone disease – may be a major cause of disability in later life with fractures of the hip, wrist and spine. It is caused by a deficiency in oestrogen, and oestrogen replacement therapy is perhaps the most powerful protection against it. HRT is usually considered to be the first line of defence for women with premature menopause to protect themselves against osteoporosis.
Osteoporosis is characterised by low bone mass (density) and deterioration of bone tissue. Another frequently used term is osteopenia which is used to define the less severe stage before osteoporosis. ‘Osteo’ means bone and ‘poenia’ means poverty. Osteoporosis is a disease of the bones that results from osteopenia or loss of bone density.
With osteoporosis, prevention is the most effective treatment. To build all the various components to maintain healthy bones the body needs vitamins C and B6, copper, zinc, manganese and glucosamine. Vitamin K is then needed to activate the whole thing. Calcium and magnesium adhere to the mesh and the body uses this to form bone.
What you eat can make a huge difference to your bone health. Calcium, whether in the form of low-fat dairy products, dark-green leafy vegetables or nuts e.g. almonds, is vitally important for bones. Current UK government recommendations are that perimenopausal and postmenopausal women should not allow their calcium intake to fall below 1500mg per day (1 pint of semi-skimmed milk contains 750mg). The problem is that absorption of calcium tends to become less efficient after the menopause. Vitamin D helps with this process and so it is vital either to add a Vitamin D supplement or make sure you consume plenty of it. It is found in oily fish, fish liver oils and fortified margarines. An alternative is to feel the sun on your skin on a regular basis. Unfortunately sunscreen will interfere with absorption of vitamin D so be sensible and go in the sun in moderation and not at the hottest part of the day. Remember you only need 15 minutes of sunshine to get all your vitamin D for the day.
Exercise is another key part of dealing with osteoporosis and the emphasis here is on weight-bearing exercise i.e. exercise which puts weight on your muscles and bones through gravity such as walking, jogging and aerobics.
You should ask your doctor to refer you for a bone scan. If this suggestion meets with a negative response, enquire whether it is possible to arrange a scan privately (the cost is usually less than £100). Ideally you want to have a DEXA or DXA scan.
Information is also available from the National Osteoporosis Society.
Heart Disease
The risk of heart disease may increase, as there is no oestrogen to protect against hardening of the arteries and other heart problems.
According to recent research, the risk of developing heart disease for women who go through the menopause before 35 is two to three times that of a woman who has not. This risk is increased further if you have had your ovaries removed. Medical opinion is that oestrogen protects the heart after menopause and, therefore, HRT is prescribed as a preventative measure for women who have had a premature menopause. It is likely that HRT will help delay the onset of heart disease, although the extent of this benefit is not yet clear. When the number of heart attacks among women who have had a premature menopause was examined, it appeared that those taking HRT were 30% less likely to suffer a heart attack. However, recent reports have suggested that this benefit to the heart may be minimal in women over 60 years of age.
There are many lifestyle changes which you can make to keep your heart healthy. See lifestyle.
Further information about how to prevent Heart Disease is available from British Heart Foundation.
Breast Cancer
For many women taking HRT, the increased risk of breast cancer is a cause for great concern. These worries may be heightened following alarmist media headlines.
All the published research so far has been on women over 50. It is thought that under this age the risk with HRT is similar to what it would have been if the ovaries had not failed prematurely. However, as far as we are aware, there has been no research conducted on women under the age of 50. For further information see Breast Cancer Care .