Making postmenopausal women aware of the benefits of Hormonal Replacement Therapy (HRT) will be the aim of Dr. Dale Wilmot when he holds a lecture on January 22 at the Chamber of Commerce at 6.30 p.m.

Information will be made available to those attending and questions can be directed at Dr. Wilmot, an Obstetrician and Gynaecologist. He is hoping the discussion will “remove a lot of the mysteries and fears that people have about Hormonal Replacement Therapy”.

“I have a special interest in menopausal management, consequently that's where my interest and efforts in trying to educate the public comes from,” explained Dr. Wilmot.

“Average age of menopause is 51 and it affects women who go through natural menopause and who go through surgical menopause. That's where they may have had their ovaries removed for some surgical reason and would have been put into menopause surgically.

“There are also some patients who go into menopause because of radiation therapy or chemotherapy, anything that destroys the function of the ovaries. Then some people have a family history of premature menopause and may go into menopause early.”

The lecture is the second in a public educational series to be held by the three physicians who operate out of the same office building on Point Finger Road. Dr. Benjamin Lau had a lecture on high blood pressure at the end of the summer and Dr. Roger Wong will also have a lecture on another topic. It is hoped other doctors on the Island will also participate in the lectures which are designed to educate the public on various health issues.

Dr. Wilmot hails from Jamaica and came to the Island just over a year ago. He did his Undergraduate, Medical School and Residency training in New York and practised for three years in South Carolina, prior to arriving here. Raising the awareness of Hormonal Replacement Therapy is his mission.

“It is beneficial to all women who are in a state of menopause, whether medically, surgically or naturally,” he stressed.

“There is a perimenopausal period where a woman may still have sporatic or regular ovarian function but is still experiencing symptoms of menopause, hot flashes, vaginal dryness, etc. These individuals can also benefit from Hormonal Replacement Therapy, before the onset of complete menopause.”

At menopause a woman's body makes less oestrogen and her menstrual periods stop. This is a natural stage in a woman's life and the decrease in oestrogen may also increase a woman's risk of heart disease and bone loss (osteoporosis).

The changes, says Dr. Wilmont, are why HRT is recommended to restore oestrogen after menopause. He explained that a similar event occurs, however more abruptly, if a woman's ovaries are removed during surgery.

Women who have a uterus at the time of menopause need to take both oestrogen and progesterone so as to protect the uterus from endometrium cancer. Women who do not have their uterus need only take oestrogen.

“It's a lifetime therapy so once you stop the hormones the benefits also cease,” Dr. Wilmont warns.

“Once a woman goes into menopause and starts Hormonal Replacement Therapy, she is basically on it for life.”

Dr. Wilmot says he finds it surprising how few postmenopausal women are aware of Hormonal Replacement Therapy and even how many fewer are actually on HRT.

“It's not very new but for various reasons patients have been very afraid of going on hormones,” he states.

“The importance of hormonal therapy is actually known for quite some time, but there are some side effects that do concern patients. Anything that you take into the body can have good effects and also side effects.

“One of the side effects that scares patients a lot is a slight increased risk of breast cancer with long term use of Hormonal replacement Therapy. That means ten years or longer.

“So far the literature shows no evidence of increased risk of breast cancer with short term use which is defined as five years or less. And even that increased risk of breast cancer is very slight, about 20 to 30 per cent for susceptible patients with long time use.”

Dr. Wilmot added: “However, it is important to know there is no increase in the death rate from breast cancer. The reason being that even patients who develop breast cancer on Hormonal Replacement Therapy, their prognosis tends to be better than women who develop breast cancer when not on Hormonal Replacement Therapy.

“That's because they detect it earlier and these tumours tend to be less aggressive than if developed in patients who are now on HRT.”

Bone loss increases significantly after menopause and is the major reason why HRT is recommended in menopausal women. In menopause a woman's bones losses strength and becomes more fragile. As a result these women are more likely to break bones. HRT is one of the best methods of slowing bone loss after menopause.

Cardiovascular disease, the leading cause of death amongst women in the United States, is more likely to occur after menopause. Once a woman's ovaries stop producing oestrogen, her risk of cardiovascular disease increases over time to equal that of a man.

Studies have also shown that women who use HRT reduce their risk of heart disease by as much as 50 per cent. Other benefits of HRT include:

A decrease in urinary tract infections

A decrease in painful sexual intercourse

A positive effect on mood

A positive effect on short term memory

Possible protection against Alzheimer's disease

“It (HRT) is not for everyone,” Dr. Wilmot agrees.

“For some patients Hormonal Replacement Therapy is contraindicative, but for the patient who has no contraindications I recommend it strongly. Of course the main focus of menopausal management is bone protection and now we have other agents, other than hormones, that can protect against osteoporosis. Fosomax, for example.

“However, those agents don't have the additional benefits of Hormonal Replacement Therapy.”

Said the Doctor: “Unfortunately, a lot of patients are not on Hormonal Replacement Therapy when I see them. I counsel them on HRT and I try to get as many on either Hormonal Replacement Therapy or bone protection as possible.

“Ultimately it is the patient's decision and you can only educate them and provide them with information for them to make an informed decision.

“Some patients are ignorant to it, but I find that most patients have heard of it but have been afraid of it and consequently there are more inclined to try Herbal regimens rather than synthetic hormones. Those are not bad but we don't have the same control and knowledge of those doses as we do with synthetic products.

“For those patients who can't take Hormonal Replacement Therapy, sometimes we do resort to use of just herbal medicines, in addition to anti-fracture agents like Fosomax.”