December 12, 2017

expert reaction to study on hormone replacement therapy to prevent chronic conditions in postmenopausal women

A new study, published in JAMA, reviewed the evidence for the use of hormonal replacement therapy for the prevention of chronic conditions, such as diabetes and heart disease, in post-menopausal women.

Prof. Saffron Whitehead, Emeritus Professor of Endocrinology at St George’s University of London (SGUL), and member of the Society for Endocrinology, said:

“The history of HRT has had a rocky ride. First oestrogen therapy was the panacea for staying young, healthy and sexy. In the early 1970’s several papers were published showing that oestrogen only therapy markedly increased the risk of cancer in the lining of the womb. Progesterone was then added to HRT preparations in women who had an intact womb. This prevented growth in the lining though women who had a hysterectomy could continue on oestrogen only therapy. In the 1990’s studies were published about the risks and benefits of HRT, notably the Women’s Health Initiative (WHI) in the US and the Million Women Study in the UK. These showed that oestrogen plus progesterone increased the risk of breast cancer, thromboembolism and stroke but decreased the risk of spinal fractures and colorectal cancers.  Women on oestrogen alone had similar risks and benefits but a lower incidence of breast cancer.

“Subsequently the data were reanalysed and showed flaws in the original analyses of the data and doubts about the benefits versus risks began to creep in. In the UK the recommendation was that women should only be treated with HRT for 2-3 years to treat menopausal symptoms such as hot flushes. Long-term use to prevent osteoporosis was not recommended and that alternative treatments were available.

“This study has reviewed the evidence of the harm and benefits of oral HRT and steroid patches. It concluded that the benefits with combined progesterone and oestrogen therapy were on risk of type 2 diabetes, all fractures, and colorectal cancer. For women on oestrogen therapy only, the benefits were for breast cancer, all fractures and diabetes. Risks of combined oestrogen and progesterone therapy included invasive breast cancer, heart disease, gall bladder disease, stroke thromboembolism and urinary incontinence. Similar harms were found in patients on oestrogen only therapy, except on breast cancer and gall bladder disease.

“Overall the recommendation, based mainly on data from the US, was that HRT should not be used to treat chronic conditions such as osteoporosis, colorectal cancer and risks of blood clots. It’s a matter of balancing risks versus benefits. No mention was made of short-term use of HRT to treat acute menopausal symptoms, which can affect the quality of life in women, or the effects of lower doses of oestrogens and progesterone.  Although this is simply a recommendation document there a still a lot of questions that need to be answered about HRT in short-term and long term treatment.”

* ‘Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women’ by Grossman et al. published in JAMA on Tuesday 12 December. 

All our previous output on this subject can be seen at this weblink: http://www.sciencemediacentre.org/?s=hrt&cat

Declared interests

Prof. Saffron Whitehead: No conflicts of interest.