HRT – The Present Position

 

 

HRT has been an excellent treatment for menopausal symptoms – flushes, sweats and many other symptoms.  It had been hoped that it would also toughen bones and reduce fractures, and also reduce heart disease, strokes and be generally beneficial in the long term.

 

Unfortunately, there were also some concerns as to whether it might have drawbacks – especially increasing the risk of breast cancer.

 

To clarify the benefits and risks, two large studies were started – one in the U.S.A. and one in Europe.  Our practice was involved in the European trial – the WISDOM trial run by the Medical Research Council (MRC).

 

Both of these trials were intended to be long-term, but have now stopped early to everyone’s disappointment, since the risks of HRT have been shown to outweigh the benefits.

 

The trials have confirmed that HRT does reduce the risk of fractures, and it also reduces the risk of colorectal (bowel) cancer.

 

However, it increases the risk of breast cancer, coronary heart disease and stroke.

 

While the actual level of risk is small, it does add up year-on-year, so carrying on with HRT gives more risk, and while the risks of fractures and bowel cancer are reduced, on balance taking HRT causes more ill-health than it prevents.

 

Short term use for menopausal symptoms should still be considered – though there is a risk of thrombosis (blood clots) in the leg veins, particularly in the first year of use (and there is a continuing risk).

 

Obviously, the decision will be one for individual women to make, and discuss with their doctors and practice nurses, but no longer can we say that the good points outweigh the bad.  The current recommendation is that HRT should only be used for menopausal symptoms and osteoporosis risk reduction.

 

One final point – the risks of osteoporosis (bone thinning) can be reduced by taking regular exercise, having a calcium-rich diet, not drinking too much alcohol, not smoking – and not being too slim!  Further, encouraging younger girls (teenagers) to exercise regularly tends to ensure the bones develop tougher, and would be an excellent prevention for the future.

 

 

 

 

CRH

25th February 2003