Another cancer scare, this time aimed at women on HRT, but should it influence individual decisions?

Hormone Replacement Therapy (HRT) has been commercially available since 1943, when oestrogen was farmed from the urine of pregnant mares.

During the years since then it has been refined to combine three types of hormones; oestrogen, progestin and progesterone.

Its main use has been to mitigate the many debilitating effects of lower hormone production in pre-, peri- and post-menopausal women.                                            

Although not effective in every case, HRT has provided an important and vital lifeline to millions of women throughout the world who had found their quality of life severely compromised by the effects of menopause.

At the height of its popularity, through the late 90s and into the 00’s over two million women in the UK were using some form of HRT.

But even from the early days of its use there has been strong and vocal opposition (mainly male it should be said) to using hormones in this way; with dire warnings that we don’t know what the long terms effects may be.

Then in 2002, a Women’s Health Initiative Study claimed their research revealed that HRT brought an increased risk of breast cancer as well as elevated incidences of heart disease and strokes.

This was supported by a 2003 ‘UK Million Women Study’ which claimed that HRT actually doubled the risk of breast cancer.

Under subsequent review, both these studies were largely discredited and, in fact, a Danish study in 2012 found that ten years of HRT actually reduced the risk of heart attacks and strokes and showed no increase in breast cancer even after 15 years of use.

The increased risk of breast cancer in the earlier studies was shown to be confined to older women in their 60s and 70s after long term HRT of 10 years or more.

But the damage had been done and many GP’s and patients were put off taking the HRT option to the point where, although there is a significantly larger pool of women who might benefit from it, the number of HRT patients in the UK has dropped to around 1,000,000.

The official advice from the British health authorities is that HRT should be used cautiously, with a minimum possible dose for not more than five years.

This is an attempt to eradicate risk from the process altogether, a worthy but possibly impractical goal.

The NHS has a fixed definition for menopause:

“In women under 50 years of age, the menopause is diagnosed after 24 months without a period. In women aged 50 or over, it is diagnosed after 12 months without a period.”

NHS CHOICES

It goes on to say that 80% of women will suffer the side effects for two to five years.

What it doesn’t say is that some symptoms, particularly flushes and night sweats, can start some years before the ‘official’ onset of menopause and last for some years afterward.

In a study by King’s College, surveying over 10,000 post-menopausal women, some were still describing symptoms up to 10 years after their final period.

Nor does a course of HRT offer any future relief; many women are extremely disappointed to discover that after five years of HRT the moment they stop the symptoms return as strong and as debilitating as before.

So what of the ‘new’ research and the increased cancer risk?

Firstly, this is not news.

The risk of ovarian cancer was identified in earlier studies as being associated with longer term use.

Even the current view sets the risk at 1:1000 HRT users of five years or more.

Secondly, it should be considered in context; the overall risk of any woman contracting ovarian cancer is 1:20.

So the increased risk from taking HRT is very small, even beyond the advisory five year limit.

Ignoring the screaming headlines and taking the official guidelines into account, the main thing to bear in mind here is that you have a choice.

There are, of course, more natural ways to protect yourself against the worst aspects of menopause, these may work for you, they are certainly worth trying.

But if you are left weighing the risks against the benefits only you can assess the value of your quality of life during these vital years against a real, but not unconscionable, future risk.

There are no right or wrong answers, only good reasons on either side and your GP, your family, and the rest of us, should all acknowledge that and support you in whatever you decide.

 

Sources: PharmaTimes et al.

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Generic 23-2-2015
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