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American trial of HRT not comparable with British users

I am concerned that the authors of your

article 'The rise and fall of HRT' (June 16) may have relied too heavily on the Women's Health Initiative (WHI) trial when

drawing their (largely negative) conclusions about HRT.

In the WHI trial the patient population differed greatly from those women who would normally be considered for HRT in Britain.

Many of the women in the trial had previous cardiovascular events and were generally much older, heavier and more likely to be hypertensive than women who would normally be considered for HRT in this country. Therefore, the WHI results are impossible to translate into normal British general practice.

The authors state: 'HRT makes no meaningful difference to the quality of life of women.' Again, as the trial participants were much older than British women on HRT this is not unexpected and so should not be taken as 'evidence' of lack of effect on life quality.

I was also concerned that the authors were recommending regular breast self-examination for women taking HRT.

This practice is now generally denounced

as being useless and indeed has, I believe,

even been classed as positively harmful

by the Canadian Medical Association.

While I am not a particular advocate of HRT, women do have the right to a sensible discussion with their doctor and I do hope this article does not lead to unnecessary alarm and women being denied treatment which may well be effective.

Dr Simon Fisher

Newcastle upon Tyne

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