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Watchdog GP advises 'short HRT bursts'

By Joanna

Clarke-Jones

A GP member of the Government's drug safety watchdog has advised GPs to prescribe HRT in bursts of a year to women with menopausal symptoms in the wake of the latest scare.

Dr Ross Taylor, a member of the Committee on Safety of Medicines, said there were several grey areas in new Government advice on when and for how long women should be treated with HRT.

The CSM last week ordered GPs not to prescribe HRT first-line for the prevention of osteoporosis and stressed the importance of regular review in women taking the therapy for menopaus-al symptoms (see panel). All women on HRT have been told to discuss the risks and benefits with their GP at their next routine appointment.

The ruling sparked a split in the CSM expert HRT group, with Professor David Purdie, consultant to the Edinburgh osteoporosis group, resigning.

Dr Taylor, senior lecturer in general practice at the University of Aberdeen, said even he was 'unsure exactly what the new CSM advice means'.

He said the guidelines did not make it clear how long it was safe to prescribe HRT for 'short-term' relief of symptoms. But he advised GPs to use HRT in 'shortish bursts', adding: 'I would be inclined to use it for a year at a time and then stop for a few months to see if symptoms recur.'

Dr Taylor, a former member of the CSM's expert HRT group, added: 'I am not sure doctors will absolutely not use it for osteoporosis as most women have some degree of menopausal symptoms. GPs could say that this is what it is being used for.'

But Dr John Williamson, senior medical claims handler at the Medical Defence Union, warned GPs they may be putting themselves at risk of legal action if they failed to heed the CSM advice.

The CSM ruling was prompted by a European-wide review of data from the US Women's Health Initiative study and the UK Million Women Study.

Professor Purdie said the WHI findings had no relevance to younger postmenopausal women, adding: 'Oestrogen still has a place in treating women in their early 50s as it is protective against fractures.'

 · HRT does not worsen breast cancer prognosis, page 15

CSM guidance on HRT

Short-term treatment of menopausal symptoms

Use the lowest effective dose for the shortest duration; review treatment at least annually

Prevention of osteoporosis

Do not use HRT first-line for the long-term prevention of osteoporosis in women over 50 at an increased risk of fractures; it can be considered for those intolerant of other therapies.

Premature menopause

HRT may be used in younger women who have had a premature menopause to treat menopausal symptoms and for preventing osteoporosis until the age of 50

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