Many women were advised to stop HRT after the original findings were published
Hormone Replacement Therapy (HRT) has been the subject of conflicting opinions since the 1960s. In the early days it seemed a saviour from the hot flushes, night sweats and severe mood swings that affect some menopausal women. Then, in 2002, the views on HRT took a dramatic turn, which led to more than a million women coming off HRT, and countless others deciding not to start taking it.
Now a new study from Denmark has added to the growing body of evidence that HRT can have health benefits, specifically a reduced risk of cardiovascular disease and death. The study found a significant reduction in the risk of mortality, heart failure and heart attack in women who take HRT for 10 years following their menopause.
1,006 women, aged 45 to 58 years old were included in the randomised trial. All were healthy and recently menopausal. 504 were put in the HRT group, and 502 were in the non-HRT group. Those women who’d had a hysterectomy were included if they were aged 45-52.
The trial ran for 10 years, but the women were then encouraged to stop using HRT because of the results of the Women’s Health Initiative and the Million Women Study (see A Brief Background, below). The women were then followed for a further six years beyond the end date of the trial.
The scientists studied the primary endpoint of the trial to see whether the HRT treatment had been of benefit to the women. This is a common approach in this type of trial. In the case of this study into HRT and how it affects heart health, the primary endpoint was the point at which a participant died or was hospitalised following a heart attack or heart failure.
During the course of the study and the six-year follow-up, a total of 41 women died. Of these, 26 were in the non-HRT group, and 15 were in the HRT group. A total of eight women were diagnosed with heart failure – seven in the non HRT group and one in the HRT group. Five women had heart attacks – four in the non-HRT group and one in the HRT group.
The study’s authors conclude that women treated with long term HRT early after menopause ‘had significantly reduced risk of mortality, heart failure, or myocardial infarction (heart attack), without any apparent increase of cancer, venous thromboembolisms (deep vein thrombosis) or stroke.” But they do stress that “due to the potential time lag longer time may be necessary to take more definite conclusions.”
Dr Claire Knight, Cancer Research UK’s health information manager said: “This is a small study that wasn’t specifically designed to look at whether using HRT was linked to cancer risk. Instead it was intended to look at the risk of heart attacks and other heart failures in connection with HRT. This, along with other concerns about how the study was conducted, means that we cannot be confident about what it says on the subject of breast cancer risk and HRT.
“A recent comprehensive review funded by Cancer Research UK estimated that just over three percent (around 1,500 cases) of breast cancers in women a year in the UK are linked to using HRT. Women should still consult their GP about whether to take HRT, and discuss the benefits and harms with their doctor to decide what’s right for them.” Cancer Research UK figures show that there were 48,417 new cases of breast cancer in women in 2009.
We suspect we haven’t heard the last of this. So should you keep taking the pills? That’s a question for you and your GP.
A brief background
Up to 2002, the prescription of HRT (which helps relieve hormonal symptoms in menopausal women) was believed to also reduce the risk of cardiovascular disease, osteoporosis and colon cancer.
However, in 2002, results from the Women’s Health Initiative (WHI) study found no cardiovascular benefits. In fact, this study found that women taking HRT (either oestrogen and progestin or progestin only) had an increased risk of stroke, blood clots and heart attack. Women taking oestrogen and progestin also had an increased risk of breast cancer.
The Million Women Study, published in the UK in 2003, also showed that women taking HRT had a higher rate of breast cancer. It seems straightforward put like that, however, the story isn’t as simple as it seems. Earlier this year (2012), the results of a reappraisal of HRT were published in Climacteric, the official journal of the International Menopause Society.
This resulted in some fairly serious questions about the validity of the original WHI study. The results came from studying older women who didn’t start taking HRT until about 12 years after their menopause started. The findings shouldn’t have been applied to younger women who were starting to take HRT close to the time of their menopause.
Read our article on this reappraisal from May 28 2012.