Ethics

Patient-centred ethics and safety are always in mind and depend on the Practitioner's continuous professional development, current and evolving world research and professionalism.

Recent Issues with Hormone Replacement Therapy

If you are currently using hormone replacement therapy (HRT) to help manage symptoms associated with the menopause, you may already have been concerned about recent possible difficulties in obtaining supplies of your medication. Things are now complicated further by stories in the media of a recent report linking HRT with an increased risk of breast cancer, even after stopping treatment (1).

Sometimes referred to as menopausal hormone therapy (MHT), this treatment involves the use of prescription medications containing an oestrogen hormone (sometimes in combination with another hormone called progestogen) to counteract the natural fall in levels of oestrogen that account for many of the symptoms associated with the menopause. These can include hot flushes and sweats, mood changes and impaired concentration, vaginal dryness, loss of sexual desire, urinary problems and joint and muscle pains, amongst others.

Studies show that as well as treating some of these symptoms, HRT can also help to reduce your risk of bone fractures linked to thinning of the bones (osteoporosis) and may also lower the risk of coronary heart disease. On the other hand, taking HRT may increase your likelihood of having a stroke or a blood clot in the leg (venous thrombosis). There is no evidence that HRT has any effect of the risk of diabetes or dementia.

This new report confirms the link between HRT and the risk of breast cancer. It also suggests that this risk is a bit higher than first thought, is related to how long a woman takes HRT and that it may continue for at least ten years after stopping treatment. (1)

Guidelines produced by the National Institute for Health and Care Excellence (2) recognise the wide variability in the range and severity of symptoms experienced by women as they go through the menopause, and therefore strongly advise doctors to adopt an individualised and patient-centred approach when giving advice about treatment.

These guidelines advise that as well as considering HRT, your doctor may also suggest taking other drugs to reduce your symptoms, recommend cognitive behavioural therapy or the use of herbal preparations such as black cohosh and St John’s wort (if appropriate).

We would always recommend that if you have any concerns about the availability or suitability of your current treatment, you should arrange to discuss this with your healthcare professional as soon as possible.

Your herbalist can also provide additional help here. We regard the menopause as being a normal part of the journey that a woman makes through her life, and that the natural hormonal changes that give rise to so many symptoms can often be helped by using a herbal approach to support you as your body adjusts to this new phase of your life.

Herbalists have much experience of helping women with these problems, and regard all patients as individuals, each with their own story to tell. We will listen carefully to you and find out about your story, before considering which particular herbs might be useful in helping you to deal with any problems or health concerns that you have. We will take time to see the whole picture.

Our approach is truly individualised and patient-centred. Just as it should be.

The National Institute of Medical Herbalists is the longest established professional association for medical herbal practitioners. Our members are all fully qualified, trained to degree standard and are fully accredited to practise herbal medicine.

(1) Collaborative Group on Hormonal Factors in Breast Cancer. (2019) 'Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence' The Lancet [Online], 1-10. Available at http://https://www.thelancet.com/…/PIIS0140-6736(19)31709…/fulltext [Accessed 30th August 2019]

(2) National Institute for Health and Care Excellence (2015) Menopause: diagnosis and management [Online] Available at https://www.nice.org.uk/guidan…/ng23/chapter/Recommendations [Accessed 30th August 2019]ction for you button - what do you want people to do now?

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