THE RISKS OF HRT: OTHER DISORDERS
The effects of oestrogen on the following disorders have been studied in some detail during the past fifty years. The impact of added progestogen is not so well understood.
HRT AND OVARIAN CANCER No consistent link has been demonstrated between HRT and ovarian cancer, but such a link has not been adequately ruled out. There is some evidence of ovarian cancer a substantial time after long-term HRT use. On the other hand, Pill-users (taking similar hormones to those of HRT but at higher doses) seem to be protected somewhat from ovarian cancer. Research in this area is continuing, but as yet no definitive conclusions can be drawn.
WOMEN WITH EXISTING LIVER DISEASE This condition becomes evident from abnormal liver function test results indicating that the liver is having difficulty doing its job of breaking down a wide range of substances. Recommendations regarding HRT for women with liver disease usually hinge on the nature and severity of the problem. In cases of severe active liver disease with abnormal liver function, HRT should be withheld. If the liver disease is mild or has resolved, HRT may be appropriate; in these cases the patch is the preferred way of administering it. This is because it is less demanding on the liver for absorption of hormones to be through the skin than via the stomach. While patches may be suitable for women with mild abnormalities of liver function, remember the reservation expressed at the beginning of this chapter about the lack of long-term research data on patches.
WOMEN WITH UNDIAGNOSED VAGINAL BLEEDING
Until the reason for unexplained vaginal bleeding is diagnosed it is unwise for women to have HRT. The safest course of action is to have the bleeding investigated. This may entail a hysteroscopy and biopsy or curettage.
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