Probably not. Symptom control and reduction of the long-term risk of fractures or heart disease are the most important reasons for HRT. The view of the Australian Menopause Society is that while most women should consider having HRT for an extended time, ‘the most important aspect of menopause management is for the individual woman to be educated and informed about benefits and risks, and to make up her own mind with the help of her informed general practitioner. Benefit clearly outweighs risks for those likely to develop osteoporotic fracture or heart disease but, for those women who have no risk factors for these disorders, the indications to take long-term hormone replacement are not at all clear cut’. Discuss the matter with your own doctor anyway.

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Such women need more intensive surveillance than usual if they try HRT. In any case, it is a good idea for women on HRT to have their blood pressure checked regularly. If significant changes occur, it is important to have a full medical assessment and prompt treatment to control the problem (with blood pressure medications).

If you have a personal history of blood clots that developed for no apparent reason, or a family history of clotting disorders, you should tread cautiously where HRT is concerned. A thorough investigation of clotting function should be completed before deciding about whether or not to embark on hormone therapy. Genevieve developed a spontaneous clot in one leg during her thirties and, many years later, when she was contemplating HRT, a full investigation of her clotting factors was carried out. These revealed some minor abnormalities. However, Genevieve decided to start on a hormone patch to relieve her wide-ranging and severe menopausal symptoms. She asked her doctor about using aspirin to minimise the risk of further clot development, and was told that this was appropriate in her situation.

If clots are triggered by something definite like pregnancy, childbirth or previous surgery, HRT in patch form may be considered suitable. Some studies suggest that HRT does not significantly increase the risk of clots. But where there is any doubt it is wise to avoid taking the hormones in pill form, giving preference to patches. This is because the liver, which plays a major role in blood pressure control and blood clot formation, may become overactive when called on to handle the larger hormone load that occurs with pill formats (the patch releases hormones more gradually).

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Your hormone therapy options include the following:

- HRT pill that combines oestrogen and progestogen

- natural oestrogen daily plus progestogen for ten to fourteen days a month

- low-dose combined Pill for women needing contraception

- the synthetic oestrogen ethinyl oestradiol, in combination with the progestogen-like substance cyproterone acetate (the combined formulation Diane-35) if acne and worrisome hair growth are problems and contraception is also needed

If you are postmenopausal and have a uterus

Your options for hormone therapy include the following:

- natural oestrogen pill daily or continous oestrogen by patch or implant, teamed with progestogen for ten to fourteen days a month (combined cyclical therapy)

- continuous natural oestrogen and continuous progestogen (continuous combined HRT)

The first of these approaches usually causes monthly withdrawal bleeds that become lighter after a few months and may continue for however long you use HRT. With the second approach, irregular bleeding may occur for the first few months but most women no longer have any bleeding a year later.

If you are postmenopausal and do not have a uterus

Your options for hormone therapy include the following:

- natural oestrogen by pill daily or continuous oestrogen by patch or implant

- natural oestrogen daily and low-dose progestogen daily (for about six months immediately after surgery for endometriosis)

- oestrogen with or without testosterone implants

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Endometriosis is one such condition. The endometrium is the lining of the womb (uterus), shed during the menstrual period, and endometriosis is the presence of endometrial tissue in sites other than the womb. In Valerie’s case, endometrial cells passed through her reproductive system to her ovaries, settling on them as well as on other parts in the pelvis and abdominal cavity. There, the endometrial cells multiplied and interfered with the normal function of her ovaries, causing

Valerie’s periods to be irregular, prolonged and painful. Intercourse was also painful, and this was not relieved by lubricants or relaxation therapy. She decided to go ahead with surgery to remove the endometriosis. Every effort was made to spare the ovaries, but the extent of the condition meant that this was not possible.

The ovaries may also be removed if they are not functioning normally, because of multiple cysts, for example. The cysts can grow as big as golf balls or footballs or any size in between, damaging other vital tissues in the process. (Surgeons increasingly try to preserve at least part of one ovary if the cysts are not cancerous.)

Then again if, before menopause, you have a hysterectomy in which your ovaries are removed along with your uterus and cervix, you can expect to experience symptoms of menopause within days or months of surgery. About half the hysterectomies carried out in the US are of this comprehensive type (in medispeak, a total hysterectomy plus a bilateral salpingo-oophorectomy). In Australia the figure is believed to be somewhat lower. Losing your ovaries has a lot of bearing on the severity of menopausal symptoms; if they are removed before menopause rather than at or after it, symptoms tend to be more severe.

The more common type of hysterectomy performed in Australia involves removal of only your uterus and cervix, not your ovaries. Somewhat confusingly, this operation is termed a total hysterectomy. In theory, a total hysterectomy should not produce menopause. The only change should be an end to your periods and removal of the problems that made the surgery necessary.

In practice, however, a significant number of hysterectomised women who still have ovaries experience symptoms of menopause up to four years earlier than might be expected.

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