Health benefits of HRT recognised after flawed study is debunked
Experts explain how hormone replacement therapy can help women
In 2002, US government researchers published what was called a landmark study on the risks for women of having hormone replacement therapy (HRT).
HRT has been used for decades to combat problems caused by menopause, and the study suggested that women taking the treatment were at increased risk of cancer, heart disease, dementia and more.
The research, carried out as part of the Women’s Health Initiative (WHI) – a series of studies focused on preventing certain health issues in postmenopausal women – has since been found to be flawed for several reasons.
These include discrepancies surrounding the type of HRT used, and it being based on HRT use by women in their sixties, who were statistically more at risk of strokes and cardiovascular problems anyway. And so the “landmark” study is now being called a “landmine”, in that it destroyed many women’s confidence in how they were managing their menopause symptoms.
Dr Louise Newson, a British family doctor and menopause specialist who recently published her third book on the subject, The Definitive Guide to the Perimenopause and Menopause, says the women in the study “were given types of HRT that we do not prescribe nowadays”.
She points out how the study authors apologised in the New England Journal of Medicine in 2016. “They admitted that people misinterpreting the results of their study is one of the main reasons that women became unnecessarily worried about taking HRT.”
Newson was so appalled at the lack of support for perimenopausal and menopausal women that she set up a dedicated clinic, founded a menopause support app, Balance – which has a million subscribers across 180 counties – and started the not-for-profit Menopause Charity.
“It is a real shame that HRT has been given such negative press that many women are worried about taking it,” she says.
Until the study, HRT was something of a rite of passage for women; in the United States, 15 million women a year were on it.
But the WHI report produced so much panic that within six months, insurance claims for HRT were down 30 per cent. By 2009 they had dropped by 70 per cent.
Dr Susan Jamieson arrived in Hong Kong in 1989 and set up a specialist well-women’s clinic. She recalls at that time no one talked much about hormones.
She says the WHI report was justified in part, and she urged her patients to stop taking HRT – which in those days came in “little packets of ‘one size fits all’ pills” – in response to it. Her concern was the treatment might cause her patients to have heart attacks.
We now know, she adds, that taking oestrogen orally increases the risk of strokes, because when medication is taken orally, it is metabolised in the liver, and the liver’s processing of oestrogen can lead to blood clots.
Jamieson says that HRT has come a long way, however. “Now it’s available as gels, creams and patches, which helps to mitigate the stroke risk,” she says.
Dr Laurena Law is another practitioner who remembers the publication of the study. “I was working in a GP (general practitioner) practice when it came out. Many doctors were caught off guard, including myself,” she says.
Law adds it has been discovered that the benefits of HRT outweigh the risks for women within 10 years of the start of menopause.
“However, if [the therapy is] started after this period of time, or when a woman is 65 or older, there does appear to be an increased risk of cardiovascular events and stroke,” she says.
The study also suggested that women taking HRT were at increased risk of developing breast cancer, but recent research casts doubt on this.
Newson says when the 2002 study was re-examined, “it found that women taking any type of HRT have a lower risk of dying from breast cancer”.
As far as treating menopause symptoms, HRT helps alleviate hot flushes and night sweats, vaginal atrophy, depression and anxiety.
“More than 30 other significant physical and psychological symptoms can be alleviated with HRT,” Law says.
She says that many women attest to getting their lives back with HRT. Jamieson similarly reports that many of her patients say HRT has been life-changing. “They absolutely do not want to stop it.”
Women can – and should – expect not just to live to a ripe old age, but also to age with optimum health.
“A couple of hundred years ago, nobody lived past 60. Now we do, so we have to change our thinking,” she adds.
Law says that each woman “has their own experience of midlife transition”, and that HRT must be personalised and isn’t the “one size fits all” it used to be.
There are alternatives to HRT, Newson says, “but HRT remains the most effective treatment” available to treat menopause symptoms, and it can also work to reduce the risk of osteoporosis, dementia and cardiovascular disease.
Thankfully, she says, “women are slowly waking up to this fact”.
It is a real shame HRT has been given such negative press
DR LOUISE NEWSON, BRITISH FAMILY DOCTOR AND MENOPAUSE SPECIALIST, AND AUTHOR