THE TRUTH ABOUT HRT
❖ There has been widespread fear and confusion around HRT for more than a decade. After research in 2002/3 suggested that combined HRT caused breast cancer and increased the risk of heart disease and stroke, the number of women using HRT fell by 66%. Since then the picture has changed dramatically, but the confusion surrounding it persists.
It’s now clear that the findings from the original research, which involved North American women in their mid 60s, many of them overweight, were misleading and not applicable to today’s 45-55 year old women who are candidates for HRT. What’s more, today’s HRT is a far cry from the equine hormones (yes, really – it was made from horse urine) used in the study.
NICE guidelines issued 18 months ago, which looked at all the available research, recommend prescribing HRT to treat menopausal symptoms, including hot flushes, night sweats, sore joints and low mood. It may also help maintain sex drive and alleviate vaginal dryness. HRT is also licensed for osteoporosis protection, particularly for women with a premature menopause. The guidelines recommend taking it for as long as necessary in the lowest possible dose. When prescribed around the menopause, the benefits outweigh the risks for the vast majority of women. To put it into perspective, 9% of breast cancers are linked to obesity and 6% to alcohol – HRT use is linked to 3% of cancers. However, a recent British study suggested that the association between HRT and breast cancer may be higher than previously thought. GH’S Dr Sarah Jarvis also adds a note of caution: ‘The menopause can devastate women’s lives, but combined HRT does come with some risk. Up to one in 50 women who take HRT for five to 10 years could get breast cancer as a result, although the risk drops off as soon as you stop taking it. Do discuss your individual circumstances with your GP.’ Although NICE does not recommend HRT for cardiovascular protection, experts say that there is mounting evidence that, far from increasing the risk of heart attack and stroke, when started soon after menopause, it is protective. Some experts, like Dr Henderson, argue that all women should be offered HRT for heart protection. ‘There are two issues here: controlling immediate symptoms and long-term protection,’ she says. ‘The latest research shows overwhelming benefits. Women who took HRT within 18 months of menopause up to the age of 60 had 50-60% lower death rates from both heart disease and stroke. It’s staggeringly simple. There’s nothing else modern medicine has to offer that provides a fraction of that benefit.’