Clearing up the confusion over HRT
Q - Do the WHI data mean we should change what we say about HRT?
A - The Women's Health Initiative (WHI) study has raised important clinical issues and we have to re-evaluate the way we prescribe HRT.
It must be emphasised this relates to the combined oral form and not oestrogen-alone preparations (hysterectomised women) and to under-50s.
This evidence of the WHI suggests that for every 10,000 women on combined HRT there would be seven additional heart disease events every year (in addition to 30 in the general population), eight additional breast cancer events (30 in the general population) and eight additional strokes (21 in the general population).
The more recent Million Women Study on breast cancer and HRT suggests 10 years' use of HRT is associated with an additional five breast cancers per 1,000 users and that the risk rises with increased duration of use for all types of HRT.
On the other hand, HRT is very effective in relieving vasomotor symptoms and has a protective effect against osteoporosis and colon cancer.
With this evidence there appears to be a limited role for HRT in well-selected peri- or post-menopausal women with moderate to severe vasomotor symptoms and its use should be limited to five years.
For protection against osteoporosis alone, SERMs or bisphosphonates should be used instead of HRT.
Presence of CVD is now considered a contraindication for HRT.
For women on HRT
the reason for prescribing should be reassessed and consideration should be given to stopping HRT.
Mr Narendra Pisal and
Ms Theresa Freeman-Wang, consultant gynaecologists, Department of Women's Health, Whittington Hospital, London