Hrt: your choice

HRT: YOUR CHOICE
Have you ever been on your way to an appointment when the car radio has blared out details of a traffic snarl on your intended route? A series of questions probably flashed through your mind. How serious is the hold-up? How long will it take to clear? Can I bypass the trouble spot? What are the alternative routes? How likely are they to be congested? What detours must I make to get to another route? Life is full of choices made under conditions of uncertainty.
Decisions about medical treatment such as HRT demand a more careful approach than choosing the route to an appointment, but psychologists tell us that the decision-making process has much in common with that described above. You form a set of expectations about the likelihood of particular outcomes, bearing in mind uncertainties about the information available. You place a particular weight on one or other of those outcomes. You take into consideration other factors that are important to you, for example the inconvenience of this approach or that, the costs involved, the effort of remembering when to do what, the experiences of your friends and others whose judgement you trust.
When Dale Spender was deciding whether or not to try HRT in her early forties, some of the considerations she took into account included the following:
- her experience of menopause, which was of drenching sweats and hot flushes that were messing up her life; and
- her expectations of HRT, which included both positive features - like relief from her symptoms - and negative possibilities such as an increased risk of breast cancer.
'Any responsible human being knows that taking drugs on a daily basis is not without risk,' she told a magazine in 1991. 'There is not a drug on the market that has not been hailed as a wonder drug and then found wanting some years later.' Dale's decision to try HRT was not the end of the story. Although the flushes and sweats eased and her life returned to 'something like a normal existence', her breasts were unbearably sore. At her doctor's suggestion she bought a cabbage, went home, tore off a few leaves and wrapped them around her breasts. 'The smell! I can't tell you. But it was no good. Nothing is.'
All in all she found the sweats more debilitating than the sore breasts, and she planned to stay on HRT until the age of fifty-two, when she would reassess the situation. Her experience of making decisions about HRT in a situation where some things are known and others are uncertain, and where some of the evidence is conflicting, is common to many women at and after menopause.
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