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Trial re-opens debate on hormone replacement therapy

By Lilian Anekwe

A major new trial has reopened up the debate over hormone replacement therapy, after concluding the treatment has substantial and wide-ranging benefits for the quality of life of older women.

The researchers called for a rethink on previous advice to prescribe HRT for as short a time as possible, after gathering data from thousands of women at general practices in the UK, Australia and New Zealand.

In 2003, GPs were advised to give HRT for menopause at the lowest dose for the shortest possible time, following findings from the Women's Health Initiative and the Million Women Study – linking treatment with cardiovascular disease and breast cancer.

But several re-analyses of the WHI results have since found the risks for coronary disease with combined HRT were not significantly increased, and that oestrogen-only HRT did not increase the breast cancer risk.

The authors of the new research – published in the latest issue of the BMJ – said the new results on quality of life, along with the recent reassuring information on adverse events, meant restrictions on prescribing should be eased.

Women prescribed HRT for one year showed significant improvements in sexual functioning, sleep problems, hot flushes, night sweats, aching joints and muscles, insomnia and vaginal dryness compared with placebo.

Hot flushes decreased from 30% to 9% in women on HRT, compared with a fall from 29% to 25% in those on placebo.

Study leader Professor Alastair MacLennan, professor of obstetrics and gynaecology at the University of Adelaide, Australia, said: ‘These gains can now be factored in to a woman's choice to use combined HRT.

‘In light of the WISDOM findings on quality of life consideration should be given to revisiting HRT guidelines.'

In total 5,692 women were randomised to either a combined oestrogen and progesterone therapy of placebo, and their quality of life assessed with a questionnaire after 12 months.

Women on HRT did not experience any significant improvement in other menopause symptoms and depression, and 9% more women on HRT did report breast tenderness and vaginal discharge than in the placebo group.

Dr Anthony Seeley, a GP in Bridgnorth, Shropshire, and a member of the British Menopause Society, agreed.

‘Women are choosing to suffer in silence, which is a shame. For things like hot flushes and sweats in particular, nothing seems to work as well.

‘On the whole it's an excellent treatment which is relatively safe.'

Improvements with HRT (adjusted difference from placebo group after one year)

Sexual functioning – 5%
Sleep problems – 5%
Hot flushes – 16%
Sweats – 9%
Muscle and join pain – 6%
Insomnia – 6%
Vaginal dryness – 5%
Source: BMJ 2008;337:a1190

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