Current Thoughts on The Safety of HRT            - Page 4 There is still a major role for Hormone Replacement Therapy in treating the long-term sequelae of the menopause Following the publication of WHI and MWS studies most advisory bodies have advised the use of HRT only for short-term use in the lowest possible dose. Thus these two badly flawed studies, the WHI in particular being of staggering clinical incompetence have erased 30 years of clinical, case control and laboratory studies indicating that HRT had a beneficial effect upon symptoms, the skeleton, mood, colon cancer, cardio-vascular disease and possibly even Alzheimer's disease. There was always an anxiety that there might be a slight increase in the risk of breast cancer but as most studies had shown this to be of a much better prognosis it was possible that this was due to selection bias or problems of precise diagnosis in an oestrogen stimulated organ. The WHI study used the wrong oestrogen on the wrong patients on the wrong age and came to the wrong conclusions by not considering the age of commencement of therapy. If one considers women who commence HRT below the age of 60 (oestrogen only arm of the WHI study) or within 10 years of the menopause (total WHI data) it is clear that the incidence of side effects are decreased. This is the important group as 97% of our patients start HRT below the age of 60. In the oestrogen only arm in the same group there was a 42% decrease in heart attacks, 28% decrease in breast cancer, 41% decrease in colorectal cancer, 8% increase in stroke (19 patients in premarin group and 19 patients in the control group) 27% decrease in deaths and a 20% decrease in Global index. There was also 22% increase in VTE. These studies did show a significant decrease in osteoporotic hip fractures and vertebral fractures in the older appropriate age group. The issue remains controversial and 'menopausologists' are by no means complacent. We do need more sensible studies without the grotesque media manipulation that has tarnished the WHI and MWS studies and thus terrified a generation of women and their doctors producing much distress. References: Studd J 'Second thoughts on the women's health initiative study: the effect of age on the safety of HRT.' Climacteric. 2004 Dec;7(4):412-4 John STUDD, DSc, MD, FRCOG Professor of Gynaecology . www.studd.co.uk . Tel: 020 7486 0497 . fax: 020 7224 4190 . Email: harley@studd.co.uk Back to top