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Menopause: Change, Choice and HRT

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By B. G. Wren and Margaret Stephenson Meere
Rockpool Publishing, RRP $24.99, pp240, ISBN 978-1-921878-69-5
Reviewed by Sam Merriel

The benefits of hormone replacement therapy (HRT) have been suggested to include the relief of perimenopausal symptoms, as well as prevention of chronic diseases such as cardiovascular disease, osteoporosis and dementia in women.

The optimal timing and duration of HRT has been a subject of confusion and debate in the medical, academic and public arenas for the past decade.

As pointed out in this book by Wren and Meere, the unexpected findings and subsequent media coverage of the Women’s Health Initiative (WHI) study in 2002, which linked HRT to increased risk of breast cancer, blood clots and strokes, caused a seismic shift in the use of the therapy by physicians.

Upon reflection, the authors share the beliefs of other academics and gynaecologists that these findings have been generalised too broadly.

As a consequence, some women’s health may have suffered as a result of the recommendations of the study author’s, the US Food & Drugs Administration (FDA) and others, and women and their doctors remain unclear about the safety, efficacy and appropriate use of HRT today.

Menopause: Change, Choice and HRT aims to inform women, and other interested parties, about the role of hormones in female growth, development and ageing.

The stages and impacts of the menopause on a woman are described and explained.

The book provides detailed information on HRT; it’s various forms, uses, benefits and some adverse effects.

Wren and Meere add their own critique of the conduct of the authors of the WHI study, the manner in which the data was interpreted and released to the public, and flaws in their methodology and analysis.

Information on the alternatives to HRT is also presented, and recommendations are given for women about vital considerations to take into account in deciding whether to commence HRT or not, and when.

This book contains lots of detail on hormonal physiology and pharmacology, and is well referenced to studies and sources of health information.

A key criticism that Wren and Meere level at the WHI study authors, as well as academics and journalists who wrote pieces on the study’s findings following their release, is that these individuals and groups used select data, low-quality evidence and anecdotal stories to campaign against the use of HRT.

This book uses some of the same techniques to communicate the benefits of HRT, and presents a subjective point of view on the issue.

The concept of Cochrane reviews and systematic assessment of evidence is introduced, but a pertinent 2012 Cochrane review of HRT titled Long term hormone therapy for perimenopausal and postmenopausal women is not even mentioned, and has findings that do not agree with the authors’ summation of the evidence for HRT.

In summary, this book contains a thorough and detailed discussion about the menopause, HRT, the recent controversies surrounding the use of HRT, and alternatives to HRT for the relief of perimenopausal symptoms and the prevention of some chronic diseases faced by postmenopausal women.

This book is not a completely objective representation of HRT, and women and health professionals reading it should also consult other sources of reliable information when making decisions about the use of HRT.