Hormone therapy danger debunked

BRITAIN: Women can take hormone replacement therapy for menopause without fear it will cause early death, the first longterm study has concluded.

The same research that originally raised fears of cancer and heart disease linked to HRT has now found it led to no extra deaths over two decades as the health risks and benefits cancelled each other out.

As a result, more women should be offered the treatment for hot flushes, night sweats and other problems, scientists said.

‘‘This is good news for women,’’ said JoAnn Manson, professor of medicine at Harvard Medical School and lead author of the study.

‘‘This fundamentally provides reassurance for women during the menopause who are seeking hormone therapy to manage bothersome and disturbing symptoms such as hot flushes and night sweats.’’

In the heyday of HRT in the 1980s and 1990s, millions of women used it to eliminate symptoms of

"This ... provides reassurance for women during the menopause who are seeking hormone therapy to manage bothersome and disturbing symptoms." JoAnn Manson, Harvard Medical School

menopause and protect themselves against heart disease. However, in 2002 data from the US Women’s Health Initiative study found that it increased the risk of heart disease and breast cancer.

After other studies also found a link to cancer, usage halved and now about one in 10 British women going through menopause is thought to be on HRT.

Scientists returned to the Women’s Health Initiative data on 27,000 women aged 50 to 79 who took HRT for five to seven years. Following them for an average of 18 years, researchers found that death rates were unaffected by the treatment, with 27.1 per cent dying during this period among those who took hormones against 27.6 per cent who took a placebo.

Heart disease deaths were also identical and there was no significant difference in the risk of dying from cancer, with 8.2 per cent on HRT dying this way against 8 per cent in the control group.

Manson said the risks of blood clots, stroke and breast cancer – all increased by HRT – seemed to be offset by the protection it afforded against fractures, diabetes and endometrial cancer.

‘‘Even though there are risks, there are counterbalancing benefits that mean the effect on mortality is neutral,’’ she said.

While taking HRT, women in their 50s were actually 31 per cent less likely to die although this effect faded once they had stopped using it.

Manson said the pendulum needs to ‘‘swing back to appropriate and judicious use for managing symptoms . . . some of the decline in use was not optimal because women were suffering from hot flushes and having symptoms that disrupt your sleep and impair your quality of life has an effect on health’’.

She added, however: ‘‘This does not mean that we’re going back to 25 years ago where hormone therapy was used for prevention of cardiovascular disease.’’

Heather Currie, of the British Menopause Society, said: ‘‘These findings should be helpful to women and doctors, especially when considering whether to start hormone therapy. Even though not every woman requires hormone therapy, they should have accurate information about menopause and treatment options.’’

Paul Pharoah, of Cambridge University, said that overall deaths was ‘‘one of the best measures of overall harm/benefit because it is a ‘hard’ end-point that can be accurately ascertained without any bias’’. –