Women on HRT run risk of ovary cancer HRT was promoted strongly by doctors in the 1970s and many women claimed that it transformed their lives. But in recent years the number of users has plummeted after a series of health scares. According to the GP Research Database of anonymised patient records, the number of women in Britain on HRT fell from two million in 2002 to one million in 2005.
The Wisdom study confirms earlier findings that women in their sixties who take HRT may suffer from heart and cardiovascular problems. The team identified 5,692 healthy women with an average age of 63, who were 15 years after their menopause, and who were registered with doctors in Britain, Australia and New Zealand. The women who had not had a hysterectomy were allocated to one of two groups.
One group was given a daily dose of combined hormone therapy (oestrogen and progestogen) and the other received a placebo pill. Women who had had a hysterectomy were divided between combined hormone treatment, oestrogen only and a placebo. All the women were monitored for an average of 12 months, and the main outcomes, such as cardiovascular disease, osteoporotic fractures, breast cancer and deaths, were recorded.
There was a significant increase in the number of serious cardiovascular events and blood clots in the group who took the combined hormone therapy, compared with the placebo group. However, the rates for cerebro-vascular disease, breast or other cancers, fractures and overall deaths were not significantly different in these two groups. In 2002 the Women s Health Initiative trial, a 15-year research programme to address the most common causes of death, disability and poor quality of life in postmenopausal women, found that those taking HRT had more heart attacks and strokes than nonHRT users.
That study reported in June 2002 that HRT increased the risk of breast cancer, heart disease and stroke. The trial was halted early and millions of women around the world stopped taking the therapy. In August 2003 the Million Women Study, a national study of women s health, found that the risk of breast cancer was doubled if HRT was taken for ten years suggesting that it could have been responsible for an extra 20,000 cases in Britain alone.
But scientists now believe that some of these risks may apply only to older women who do not routinely take HRT. The Wisdom study authors say that more research is needed to assess conclusively the long-term benefits and risks. The follow-up period in Wisdom was short because of the early closure, and the power of the study was greatly reduced by the curtailed recruitment, which also led to relatively few women being in the younger age groups, they write.
In an editorial, Helen Roberts, of the University of Auckland, says that the new findings do not change advice to postmenopausal women. Healthy women in early menopause are unlikely to face substantially increased risks when using hormones for a few years, she writes. However, long-term use of hormone replacement therapy to prevent chronic disease is no longer recommended as the available randomised evidence shows that the negative outcomes outweigh the positive benefits.
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