The facts and risks of using HRT
HRT has been the main treatment for hot flushes, sweats and other symptoms of the menopause since the 1970s. For over 30 years, women have used HRT, mostly unaware of the risks.
This all changed in 2002, when the US Women’s Health Initiative stopped a trial involving over 16,000 women, 3 years early, when it found that HRT usage increased the risk of breast cancer, heart attacks, strokes and deep vein thrombosis. The independent board which was regularly reviewing the trial findings, had to conclude that the risks of using HRT outweighed the benefits.
Dealing with the Health Risks.
Given the millions of women who were taking HRT globally, it was recognized that these results represented a serious public health issue.
Subsequently in July 2005, HRT was officially classed as cancer-causing by the World Health Organisation’s cancer agency.
In recent years, more health concerns have been raised over the use of HRT, such as an increased risk of dementia and ovarian cancer. But without a doubt, it is the fear of breast cancer, which in the UK alone, has claimed the lives of over 20,000 women since the 1990s, that causes the most alarm.
Perhaps the best objective view on HRT usage is summarised by the position taken by four respected medicine control agencies whose role is to enhance and safeguard public health:
The UK Medicines & Healthcare products Regulatory Agency
HRT is an effective therapy for the short-term relief of menopausal symptoms; the minimum effective dose should be used for the shortest duration. Because of the associated risks, HRT is not the first treatment of choice for the long-term prevention of osteoporosis in women over the age of 50.
All women who wish to start HRT should discuss the risks and benefits of treatment with their doctor. Women on HRT should have regular health check-ups, and the need to continue HRT should be re-assessed at least annually.
Australia’s Department of Health & Ageing Therapeutic Goods Administration
HRT remains an effective short-term treatment option for controlling the symptoms of the menopause. For each woman considering use of HRT, it is necessary that the benefits be weighed against the several risks that have been observed, including that of coronary heart disease within one year and breast cancer after more than one year of therapy.
Periodic re-evaluation of whether HRT should be discontinued is recommended at not more than six monthly intervals. Hormone replacement therapy is not recommended for any long-term prevention of any disease, including the prevention of osteoporosis, as the potential harm may outweigh the potential benefits.
New Zealand Medicines & Medical Devices Safety Authority
HRT should normally be used only where menopausal symptoms are disruptive to the quality of life of the woman;
HRT should not be used for the primary or secondary prevention of coronary heart disease or stroke;
In most circumstances, the risks of long term treatment outweigh the benefits; and combined HRT generally should not be used for longer than 3-4 years;
Oestrogen-only HRT increases the risk of breast cancer and venous thromboembolism to a similar extent as combined HRT;
All prospective and current users of HRT should be advised of the risks and benefits of oestrogen and progestogens;
The need for continued treatment with HRT should be reviewed at the woman's next visit to her General Practitioner and thereafter on a yearly basis.
The decision to use HRT should be based on particular needs and health, and made after a careful medical evaluation. Women should:
Discuss the benefits and risks of the various forms and dosage levels of HRT in light of their medical history with their GP.
Talk to their GP about how to manage menopausal symptoms and any post-menopausal conditions. For example, there are effective alternative therapies for osteoporosis.
Eat a healthy diet, exercise regularly, drink alcohol only moderately and do not smoke. These are important steps to prevent osteoporosis and coronary heart disease.
Not use HRT for the prevention or treatment of coronary heart disease or stroke.
Be aware that whilst HRT is effective for the control of hot flashes, night sweats and vaginal dryness, even short-term use is associated with an increased risk of blood clots, stroke and coronary heart disease.
HRT should only be used if symptoms are severe and if women have been fully informed of the risks.
HRT requires regular medical evaluation.