Guild of Health Writers

Wednesday, 10 February 2010 6.30pm

For our February seminar on Women’s Health, we were lucky enough to have as speakers, Michael Savvas, FRCOG, Consultant Gynaecologist at Kings College Hospital London, and an expert on the menopause, and Michael Dooley, FROCG, Consultant Gynaecologist, Medical Director of the Poundbury Clinic, London and Dorchester, Foundation Fellow for the Prince’s Foundation for Integrated Health, and author of Fit for Fertility. Nicola O’Connell introduced our speakers to the Guild members who had braved the snow to attend the meeting. Guild newsletter editor Lesley Dobson reports:

Michael Savvas has a special interest in reproductive endocrinology, including the menopause, infertility and IVF. Taking the question "Does HRT really deserve its bad press?" Michael Savvas began by discussing the ways in which the menopause can affect women. As well as the hot flushes, mood swings, loss of concentration and decline in libido, there are the long-term effects of osteoporosis, and its potentially serious consequences, and increased risk of heart disease.

HRT is known to help with the day-to-day side effects, and can help prevent osteoporosis. Mr Savvas explained that taking HRT for five years reduces the risk of life-threatening osteoporotic fractures by 50%. However, it has had a great deal of bad press, much of it following the findings of the Women’s Health Initiative (WHI) studies launched in 1991in the USA.

Due to run for eight and a half years, the study was stopped early, because the results showed that breast cancer cases had reached the study’s safety limit.

It was this perceived increased risk of breast cancer that triggered the scary headlines, and had women dropping their HRT tablets in the bin. Since the initial reports the debate has raged on, causing confusion and anxiety. Where do we stand now, as possible candidates for HRT, and as health journalists?

Michael Savvas, who prescribes HRT, pointed out some of the problems with the WHI study. These include the age of the participants. Many were 20 years past the menopause, and even the younger women involved were long past their menopause, so too old to be representative of typical HRT recipients. Many of the patients were overweight, and the study also used a specific type of HRT. The same results may not have arisen with other HRT preparations.

Michael Savvas concluded that, properly prescribed, with the correct dose and combination, HRT has potential benefits, particularly the prevention of osteoporosis. To get the best advice, whether as patients or journalists, he advised that it’s best to consult an expert in the menopause and HRT.

Michael Dooley takes a holistic view of fertility, and explained how important it is to talk to everyone involved. "It’s teamwork, to help the couple have a family. And we’re also here to help couples live with the problem, it’s not just about conception."

His approach, he explained, is to look at the investigations as a journey, starting with natural intercourse, then IUI, IVF, etc. putting it all together over a year. Asking why people have come to see him is important – they may just want to know why they are having difficulty conceiving, or they may not care what the problem is, they just want a baby.

Over-the-counter products, such as urine tests for luteinising hormone, thermometers for the timing of ovulation etc. can be useful, but need to be part of the overall programme. He is a firm believer in acupuncture, and in lifestyle modification - diet, exercise, stress management and education. For instance, patients with a BMI of more than 29 are likely to take longer to conceive. Alcohol can reduce fertility by 50%, and smoking and stress also affect the ability to conceive.

"We look at all the options – natural cycles, lifestyle changes, IVF, and egg or sperm donation for instance. One of the worst things for a fertility investigation is IVF," Michael Dooley explained.

"IVF gets the egg and the sperm together in the laboratory, but there is no good test for how well the eggs and the sperm are being transported in the body." There are many ways of tackling the problem of infertility – lifestyle advice, assisted conception, egg donation, sperm donation and adoption. The way forward is to consider them all, use the most appropriate resources in each case, and make everyone involved a part of the team.