New study says HRT risks far lower

Aug 7 2005

Women battling to deal with the miserable effects of the menopause, will be even more confused by the release of a new Australian study, which says that a woman's risk of developing breast cancer after taking hormone replacement therapy (HRT) might be lower than previously thought.

The researchers at the University of Sydney in Australia found that HRT increases a woman's cumulative risk of the disease, but only slightly, and the use of oestrogen only, and of combined oestrogen and progestogen hormone therapy, at age 50 for about 5 years, hardly had any impact at all.

But taking the combined therapy for 10 years did raise the cumulative risk by 7.7 percent.

This of course contradicts earlier research, which has suggested that combined therapy could double a woman's normal risk of developing the disease, and prompted millions of women to abandon the therapy and see a return of the symptoms.

In Europe, the combined HRT is the most popular therapy, because it lessens the risk of cancer of the womb, which has been linked with oestrogen-only HRT.

In recent years, studies have claimed HRT increases the risk of some cancers but protects against other conditions such as heart disease and osteoporosis.

Other studies then said that certain formulas posed no breast cancer risk, but HRT's longer-term health benefits on the heart and bones were not clear, or else it's other risks outweighed any benefit.

Now this latest study which says HRT does increase breast cancer risk, but no where near as much as others may have led us to believe, will leave women even more confused.

Surveys in the U.S. and New Zealand have shown, that fifty percent of women have either stopped or are concerned about using hormone replacement therapy (HRT) following the mixed reports, and doctors in the UK also agree that many women are still worried about starting or continuing to use HRT.

Currently medical experts in the UK are saying that women should take the smallest possible dose for the shortest time to relieve symptoms of the menopause, and should be reviewed annually to check whether they should still be taking it.

The Medicines and Healthcare products Regulatory Agency and the Committee on Safety of Medicines, says that with prolonged use the risks may begin to outweigh the benefits.

Longer-term use of HRT does appear to protect against osteoporosis, but doctors believe that HRT should only be used in women at highest risk of fractures, who are unable to take other osteoporosis therapies.

However many experts disagree with what the risk estimates are based on in some studies, and suggest that some bear little resemblance to the majority of women who use HRT in the UK.

The studies have discouraged many women from taking HRT as much of the publicity has been emotive.

Mr David Sturdee, consultant obstetrician and gynaecologist at Solihull Hospital has said that it is important to get the studies into perspective.

He gives the example of the large U.S. study, the Women's Health Initiative, which looked at women who were much older, in their early 60s, and who were taking much higher doses of HRT than is used currently in the UK.

Sturdee believes for women in the UK receiving treatment for the menopause, there is every reason to believe that it is a 'perfectly acceptable and reasonable thing to do for a limited period of time'.

He said that although longer HRT use did increase the risk of certain diseases such as breast cancer, the actual numbers involved for a whole population of women were small.

Other research has suggested oestrogen-only HRT did not increase breast cancer risk, while other studies said it did, and Professor David Purdie, from the Edinburgh Osteoporosis Centre agrees that women must be thoroughly confused. He believes that some women may benefit from longer use of HRT to prevent osteoporosis, even though guidance only advises it is used if women also have menopausal symptoms.

The Royal College of Obstetricians and Gynaecologists says that most women use HRT for menopausal symptoms for less than five years.

Dr June Raine from the Medicines and Healthcare products Regulatory Agency (MHRA) also says it is important for women to weigh up their own risks and benefits with the help of their doctor when deciding whether to begin, continue or stop treatment.

She said the MHRA was keeping on top of all the data as it came out and, with the advice of the CSM's Expert Working Group on HRT, was updating its advice accordingly.

Dr Raine hopes and believes, the drop in HRT use was because women were making well informed decisions about their treatment rather than being discouraged from taking it by reports of adverse side effects.

The one thing that is crystal clear, is that the onus is on women to calculate their own risks and benefits.

The Australian study is published the British Medical Journal.