MENOPAUSAL HORMONE THERAPY TIED TO FECAL INCONTINENCE
MENOPAUSAL HORMONE THERAPY TIED TO FECAL INCONTINENCE
The title of the article I have chosen
is: Menopausal Hormone Therapy Tied to Fecal Incontinence. I have linked
it down below. It was published on Medscape Medical News by Miriam E Tucker on
February 24, 2017.
The article talks about some
problems that could cause Hormone Therapy. As we all know nowadays, there are
so many risks of taking therapy based on hormones due to its adverse effects
like risk of breast and ovary cancer, skin problems, etc.
I have chosen this article because I
think the Hormone Therapy has been developing a lot during the last years and
it seems really interesting to me. What do you all think about new therapies?
It is widely known that if you do not
moderate the doses of this kind of therapy (as in other therapies) you have a
much higher risk of causing problems than if you moderate them.
The doctor should guide and help the
patient during the treatment, ensuring that the medication the patient’s taking
is not excessive. He should also advise the patient for discontinuing the
treatment, and also trying to make sure the patient understand that it’s such a
big importance, and that he has the main responsibility to not exceed the
recommended dose. What do you think about all this? Who has the biggest
responsibility in this aspect?
Back to the article, this new
research suggests that the use of menopausal hormone replacement therapy raises
the risk for faecal incontinence (FI).
The FI risk’s prevalence rises with
age. Its risk attributed to hormone therapy in the study was big enough to be
significant among women who already have mild leakage due to diabetes mellitus
(DM), multiple vaginal births or some neurologic conditions.
Here is where I would like to start a
little debate about the necessity of initiate a treatment with hormone therapy.
Try to imagine the following situation: the patient is a middle-aged woman with
good quality of life who really could have benefits from this therapy because
of her menopausal vasomotor symptoms. Do you think that the benefits of the
therapy could outweigh the risks, or do you think is not worth giving the
patient something that may push the FI over?
Another aspect the article mentions is
that the solid or liquid incontinence (FI in particular) is considered as a
kind of taboo in our society. They talk about the importance of fighting
against this taboo. I actually agree with them in this issue because sometimes,
people who suffer this problem don’t want to talk about it. The consequence of
this taboo could result in both patient’s discomfort and diagnostic delays.
Have you ever thought about all
these points? What do you think about this therapy? What do you think about its
use on menopause? Which is your point of view about the taboos nowadays? Let me
know your opinion!
Monday, 6th March 2017
Maria Calderó Torra.
Dear Maria,
ReplyDeleteI appreciate that you brought up this topic as I hadn't considered it before.
If we talk about the responsibilities I think that the doctor should inform properly to the patient and ultimately the latter should take all decisions.
These treatments increase considerably the incidence of FI and, as you stated, of cancer. Nevertheless, the incidence of FI is "only" 5% greater at maximum compared to non-users, according to the article data. From my point of view, an exploration of the sphincter functioning would be the decisive factor in order to provide an optimal assessment to the patient. As a professional, I would still propose this treatment on menopausal patients unless the sphincter is already notably dysfunctional.
When it comes to taboos, I agree that this is one of them. Unfortunately, society still carries many taboos. Moral doesn't develop as quicker as scientific knowledge!
Hello Maria,
ReplyDeleteI´m glad you chose this article as I think hormone therapy in menopause is a very debatable topic.
In my opinion, these types of therapies can be very beneficial to improve the vasomotor symptoms of menopause, but I think not all women are good candidates to take it.
As you have said, the benefits of any therapy must be greater than the risks and this is what must be explored in each patient per individual.
That is why I believe that the greatest responsable in this is the doctor. He has to evaluate if a therapy is suitable or not for each patient and must determine the doses and duration of treatment. It is also doctor´s responsibility to inform patients of the risks that the treatment may entail and the importance of compliance with the doses.
As the article says, the greater consumption and greater duration of the treatment greater risk of developing fecal incontinence, especially in women who already have slight leaks by other medical causes. That is why I believe that these women should not take hormone replacement therapy, because the risks are high.
Their use should be restricted to relatively healthy women who actually have real benefits from therapy, always avoiding long-term treatments.
Another aspect that we should consider is the belief that hormone replacement therapy is a source of youth and it is the doctor who must inform the patients that this is not so, to avoid the desire of many women to initiate the treatment without really needing it.
Regarding to the taboo that exists around fecal incontinence, I believe that a possible strategy to solve the problem could be for health centers and especially doctors, to give more information about it, to ask patients more about it and to try to improve the patient-medical relationship so that the patients have more confidence to speak openly about their problems without shame and thus to be able to diagnose and treat precociously this problem.
What do you think about this? Do you think that it would be a good strategy?
Arantxa Chivite Jimenez
06/03/2017
Hi Maria,
ReplyDeleteI found this article very interesting. First of all I think menopause is a very difficult stage of live for many women. Although is a natural change, and specific treatment is not usually needed. However some symptoms may be improved with treatment.
I think it is important to develop new therapies, after all as a doctor our first and main interest is provide better quality of life to each patient.
The doctor has a lot of responsibility here, in one hand because the higher risk of cancer and faecal incontinence and in the other hand making sure the patient understand that she can’t exceed the recommended dose. I agree with Victor, as a doctor we must inform properly the patient, and let the patient take the decision.
As a professional I wouldn’t propose this treatment if the woman already has some risk developing cancer or if the sphincter is already dysfunctional. I have to agree with Arantxa, this treatment should be restricted to healthy women who actually have real benefits and actually need it.
About the taboo, I think it is very sad that in twenty-first century, the society still carries so many taboos. In order to finish with these prejudices I think we have to provide more information to the society, especially in health centers .
Hello Maria,
ReplyDeleteWhen I read your publication the first thing that has come to my mind is: why do we try to have nature under control? Of course, I agree to palliate symptoms in a way that supposes a better quality of life but I think that we are taking this far away. I agree with Diana too. Menopause is a very difficult stage of life for many women but a natural change. In my opinion, specific treatment isn't necessary.
Taboos in our society are a long topic to debate. In terms of improving this one in particular, as Arantxa has said before, we should give more information about it; menopause is not disease, it is nature. We have to make society aware of this to end with this taboo.
Finally I would like to conclude by saying that as health professionals we have on our hand to beat so many taboos that are still holding our society, so we can "change the world", even if it is only a small part.
Hi Maria!
ReplyDeleteTo be honest, I was not aware of the effect of FI that was tied to menopausal hormone therapy. It is quite obvious that this effect, just as the rest of side effects of most pharmacological treatments, is dependent on the established dose. That is why I believe it is the doctor’s function to keep the patients thoroughly informed and analyse risks and benefits, always letting the patient make the final decision whether to start the treatment or not.
As Diana and Clara, I am of the opinion we all should keep in mind menopause is just the time in a woman’s life when the function of ovaries ceases. That means it is a normal part of life and not a disease that requires treatment: it is not indispensable to take prescription drugs to cope with it. It is undeniable that symptoms such as hot flashes, mood changes or fatigue may be included, but we can also take into account the existence of an array of natural alternatives that can help us alleviate uncomfortable or distressing symptoms.
Hello María
ReplyDeleteI find very interesting that you have chose this topic because menopausal hormone therapy is widely used nowadays. Honestly, except women that have a lot of problems related to menopause, the hormone therapy should only be used in the ones who really need it. It is not good to introduce in one’s body any hormone if there is no necessity to do so. I agree with Clara in the fact that specific treatment is not required for every women.
Not only fecal incotenence but other health problems are taboos in our society and is a task for doctors to make them into common issues that can be treated as any other. Moreover, fecal incontinence is an effect that appears according to the dose, this is the reason why there must be an strict dose control at the time of prescribing.
This comment has been removed by the author.
ReplyDelete