“H,R,T” are three little letters that spread fear into the hearts of most female patients! This is predominantly due to media reporting of a study in the 2002 that suggested that HRT was linked to a “markedly increased risk of breast cancer”. Now, nearly 20 years later, it is widely felt that menopausal symptoms are undertreated and that HRT, while not without risks, is effective, underused and should be a first line treatment for most women. So why has it come full circle?
In 2002, the Women’s Health Initiative (WHI) study was the study that reported findings that appeared to contradict previous research in that it suggested HRT was associated with a widespread increase in breast cancer, heart disease and leg and lung clots. The main problem with this study was the age profile of the women studied- their average age was 63. HRT these days is mostly reserved for women at the start of menopausal symptoms in their late 40s and early 50s. Therefore, a study which focused on women in their 60s is not relevant to the health of the women who we target most for treatment in 2019!
However, it did give us useful information regarding HRT use in these older women. If you are more than 10 years into the menopause, HRT is not for you as the risk of cardiovascular disease and breast cancer is significantly raised.
If, on the other hand, your menopausal symptoms started less than 10 years ago, we now believe that there is no increased risk of a heart attack or a stroke on HRT. You have a very small increased risk of breast cancer but this only applies if you take the combined (ie both oestrogen and progestogen) therapy for >5 years. If you are taking one hormone (ie oestrogen only) HRT, your risk of possible breast cancer only appears to be increased if you take it for >10 years. Shorter term treatment (which we encourage) seems to have no increased cancer risk. You do have a small increased risk of leg and chest clots. However, this risk is similar to the small risk of a clot that every young woman on the combined contraceptive pill experiences!
On the back of this, the National Institute for Clinical Excellence in the UK, also known as “NICE“, recently published guidelines and advised that, in women without contraindications, it is the most effective treatment for relieving symptoms and should be used more often. Contraindications include anyone who has had a heart attack or stroke; anyone who had a previous clot in their leg or chest or anyone who has been menopausal for at least 10 years. Contrary to popular belief, a family history of breast cancer is not a contraindication. Nor too is controlled high blood pressure!
You should educate yourself in order to know what questions to ask your GP and decide on the best preparation for you. Many women find it very helpful to avail of free to download pictograms to help you to negotiate and come to a shared decision with your Doctor. These are available from the Primary Care Women’s Health Forum at www.pcwhf.co.uk. Other useful resources include the Women’s Health Concern run by the British menopause society. Their website gives a lot of very readable information regarding HRT and can be found at www.womens-health-concern.org.
Let’s banish those horrible hot flushes for good!