Are you afraid of aging?

Are you afraid of aging? Is Hormone Replacement Therapy a good option to stop yourself from looking old?

A heavily botoxed woman, sitting in the chair in front of me, has a question that is difficult to answer. She is menopausal and wants to know if undergoing a Hormone Replacement Therapy (HRT) would help her look younger. The pendulum of HRT has swung through the ages — few decades back doctors used to recommend it to everyone and now they fear HRT could lead to cancer, reducing this practice to disrepute.

Are you afraid of aging?

Nevertheless, it must be kept in mind that several studies have suggested that HRT has a beneficial effect on the skin, particularly in response to skin thickeners and collagen content. The largest multicentre study, NHANES 1, a study conducted on 3,825 women who underwent HRT found one third fewer wrinkles than in their counterparts and that their collagen content of skin was significantly high. Collagen is the substance responsible for skin elasticity.

Studies with various modes of hormone replacement such as skin application of estrogen, with vaginally applied progesterone and estrogen with vaginally applied progesterone have also been conducted. The findings suggested that skin aged from sun exposure and skin protected from such exposure, both benefited significantly. Although a majority of publications consider the influence of HRT on the skin to be positive, some studies have shown that HRT does not benefit skin and collagen level.

Plant estrogens were discovered as early as 1926. Phytoestrogens, the plant estrogens, are present in large proportion in Asian diet, and is one of the main reason Asian women suffers less symptoms from menopause. A European study, done on 234 women over 12 weeks, in which they were made to apply plan estrogen on skin, suggested that phytoestrogen decreases skin dryness and roughness by 32.9 per cent and 22 per cent respectively. Facial wrinkles were reduced by 22 per cent and skin looseness was significantly reduced by 29 per cent.

Several large studies have shown adverse effect of HRT on various organs, so most doctors do not consider skin ageing as an indication for prescribing HRT. Though plant estrogens appear to be an alternative way of benefiting the skin, more data is yet to be collected on its adverse effect. Besides benefitting the skin, estrogen therapy is extremely effective for controlling the vasomotor and genitourinary symptoms associated with menopause. More than 50 trials demonstrate that hormone replacement has salutatory effects on the bone and rapidly increase bone density at the spine by 4 to 6 per cent and at the hip by 2 to 3 per cent and lowers the risk of vertebral fracture and hip fracture in women on HRT.

However, there are certain definite risks of HRT. At least 30 observational studies found a tripling of ovarian cancer among people who used only estrogen in a short term of 1 to 5 years, and a 10-fold increase in users over 10 years or more. It causes cancer of the lining of the uterus or endometrium. The use of progesterone, which opposes the effect of estrogen on the lining of the uterus, eliminates the risk. The other problem is clots in the veins of the legs. The Women’s Health Initiative study showed there was a two-fold increase of risk of clots in the veins of the legs and dislodging of these clots, which then travel to the circulation of lungs and produce blocks in the pulmonary artery, with catastrophic results at times.

Skin applications of estrogen, on the other hand, appeared to be a safer alternative. There is an increase in breast cancer with those that use both estrogen and progesterone by 24 per cent over 5 to 6 years. Moreover, the use of estrogen alone, it shows, do not result in an increased risk of breast cancer. In fact, certain studies even showed a decrease in breast cancer rates. There is also a chance of gall stones on HRT and estrogen skin application may be the safer alternative in this situation. The effect of HRT on heart, however, still remains unclear.

Many observational studies had previously also suggested a beneficial effect because estrogen lowers the bad cholesterol and increases good cholesterol, but it affects other biomarkers of heart risk adversely. HRT reduces the risk of cancers of the colon and rectum, but there may be an increase risk of dementia with HRT. Taking all this data into consideration I did suggest to the patient that she think it through before she decides what she would like to do.



Are you afraid of aging?

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