HRT: experts slam ‘wasted decade’

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Professor Hickey said the drop in levels of the hormone oestrogen that occur during the menopause may affect key parts of the brain responsible for memory and concentration including the hippocampus, the middle, and the prefrontal cortex.

London - Thousands of women have had a “wasted decade” of suffering since the hormone replacement therapy scare (HRT), according to an international panel of experts.

A major reassessment of the research into HRT has concluded that menopausal women were the victims of “mass fear” generated by findings from 10 years ago.

Many of the conclusions reached by the 2002 study, including the raised risk of breast cancer, have now been overturned.

British doctors are calling for the rules on prescribing HRT to be rewritten, allowing a new generation to benefit from bone protection and improved quality of life.

At present, women in their 50s are told to use hormone replacement therapy drugs for the shortest time possible and not for longer than five years.

Some younger doctors have never prescribed HRT because they wrongly believe the risks of the treatment outweigh the benefits, it is claimed.

The new analysis of the evidence by leading experts – including clinicians from the US National Institutes of Health who worked on the original Women’s Health Initiative (WHI) study – is published in a series of articles in Climacteric, the journal of the International Menopause Society,

The scare began in 2002, when the WHI study was halted three years early because researchers claimed women using HRT were at higher risk of breast cancer, heart disease and strokes.

This contradicted previous research which suggested oestrogen guarded against heart problems. Afterwards, about one million women in the UK stopped taking the treatment – which was used by two million at the height of its popularity.

HRT is normally prescribed to menopausal women in their 50s to combat symptoms such as hot flushes and mood changes, although it also protects bones.

But in the WHI study, HRT was also given to women in their 60s and 70s who had gone through the menopause years earlier. The average age of the women in the study was 63.

Fresh analysis of the data found the extra health risks applied only to the older patients, who would not normally use HRT.

Indeed, the drug was shown to cut heart attacks among women in their 50s, who were at no higher risk of strokes and had a lower risk of death from any cause compared with those not taking HRT.

The reappraisal found that the evidence has changed over the past 10 years, and there is now a consensus that the absolute risks for a woman of taking HRT in her 50s are “extremely low”, according to Climacteric joint editor-in-chief Dr Nick Panay.

He added: “The benefits far outweigh the risks for the majority of women choosing to use it.

“We need the official authorities to recognise this and issue updated recommendations about HRT use which are less draconian.

“This has been a wasted decade for thousands of women whose quality of life could have been improved. The big scandal is their risk of osteoporosis could have been reduced.”

Panay, who is also the chairman of the British Menopause Society, added that the absolute risks of breast cancer for women using HRT were low.

About one extra case occurs per 1 000 women taking HRT for one year and the risk starts rising only after seven years of use, he said.

He went on: “HRT is safe for women who need it in their late 40s and early 50s. The WHI study gave it to older women who would not normally take it.”

He said “mass fear” was generated among women and doctors, and an “entire generation of younger doctors has never prescribed HRT”.

WHI study leader Dr Robert Langer, of the Jackson Hole Center for Preventive Medicine in Wyoming, said lessons had been learned.

“Overgeneralising the results from the women who were – on average – 12 years past menopause to all postmenopausal women has led to needless suffering and lost opportunities.

“Sadly, one of the lessons from the WHI is that starting HRT 10 years or more after menopause may not be a good idea, so the women who were scared away over the past decade may have lost the opportunity to obtain potential benefits.”

WHI researcher Professor Matthew Allison, of the University of California, San Diego, said: “Being obese, not exercising or excess alcohol consumption confer higher absolute risks for breast cancer than HRT use.”

TIMELINE

2002: US doctors published early findings from the WHI study which was stopped because of safety fears. It stated that long-term use of HRT was linked to higher risk of heart disease, strokes and cancer.

2003: British experts at Cancer Research UK published their Million Women Study (MWS) which claimed HRT users were at double the risk of breast cancer. About one million British women stopped taking it.

2004: Second MWS report said the breast cancer risk for women in their 50s using HRT for five years is 50 percent higher. UK doctors were advised to prescribe the “lowest effective dose for shortest possible time”, with annual reviews.

2007: WHI researchers published new analysis showing women on HRT were not more at risk of heart problems – and could be less at risk than non-users. British doctors were told HRT should be used only to prevent osteoporosis in women who could not take other medicines.

Another WHI analysis showed women in their 50s taking HRT have healthier arteries as a result, which could protect them against heart disease.

2011: Fourth MWS report said the increased risk of breast cancer from HRT reverted to level of non-users two years after stopping it.

2012: Reappraisal by international experts said HRT has “low risks” and regulatory bodies must update advice about use. – Daily Mail

HRT: pros and cons

The SA Menopause Society discusses the pros and cons of HRT on its website – www.samenopausesociety. co.za – and concludes:

“As with most interventions, there are benefits and drawbacks to taking menopausal hormone therapy. Treatment needs to be tailored to each woman’s needs. The guiding principle should be to take the smallest possible dose for the shortest time necessary.

“There appear to be few problems related to its use for the first five years. After that, women – with guidance from their doctors – should come off therapy and see how they cope. Should symptoms become severe, therapy can be resumed – but should be re-assessed yearly.

“Mammography, bone density assessment and cholesterol measurement can help you and your doctor assess your health profile and decide on correct management.

“It is also important to realise that lifestyle interventions such as correct diet, exercise and stress relief are essential to health and well-being in the menopausal years.” - Daily News

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