New figures show HRT prescriptions are at a record low. But has the breast cancer risk been overstated?
By Victoria Lambert
Published: 7:00AM BST 22 Jun 2009
The symmetry is neat: a million women in the UK have reportedly stopped taking hormone replacement therapy (HRT) thanks to the Million Women Study. This investigation from 2003 concluded that women on HRT demonstrated a twofold risk of breast cancer.
The study, along with a report by the US Women’s Health Initiative (in 2002) which linked HRT to a twofold risk of heart disease, sparked such fear that the number of prescriptions issued fell from six million in 2001 to three million by 2005. The figure is now closer to 2.5 million.
In February this year, the European Journal of Cancer revealed that in 2000 more than 40 per cent of women aged 50-54 were taking HRT, and the figure was more than 35 per cent in the 55-59 age group. By 2006, HRT the number of users among 50-54 year olds had dropped to around 20 per cent, and among 55-59 year olds the percentage was down to 15 per cent.
Experts at Cancer Research UK believe there is a direct correlation between the fall in the number of women taking HRT and the number diagnosed with breast cancer. Their statistics show a drop of nine per cent among women aged 50-54 and a fall of five per cent in the older age group. (Other researchers have attributed the decrease to the success of the NHS breast-screening programme.)
Now, however, GPs and gynecologists are warning that the pendulum has swung too far. They say that hundreds of thousands of women who would benefit hugely from HRT are being denied the safe help they need. They argue that a possible increased risk of breast cancer is not the only factor that should be considered. Women need to know that replacement oestrogen can prevent osteoporosis, uterine cancer and heart disease in certain risk groups, while alleviating menopausal symptoms that range from hot flushes and mood swings, to a depressed libido, and insomnia – both of which can have a devastating impact on women’s lives.
HRT was developed to counter the fall in levels of oestrogen and progesterone that occur when a woman enters the menopause. The average age of the menopause is 51, although there are huge variations. It is still a relatively new science and it remains highly controversial. The first menopause clinic in Britain was set up in Birmingham only 40 years ago by Professor John Studd. He takes issue with the studies that have dissuaded so many women from using HRT.
“I would disregard all the WHI 2002 data concerning women aged under 60 because the side-effects reported were age-related and occurring in women over 70 who started HRT using too high a doseof a combined oestrogen progesterone therapy no longer in use. Some of the original investigators are now going over their findings and changing their minds. The Million Women Study has been utterly discredited because of eccentric collection of data, relying as it does on a single questionnaire, rather than in a clinical trial,” he says.
“HRT is very, very safe – certainly in women under 60. There is almost no evidence that HRT is dangerous for women below that age. In fact, it is very important for them. HRT deals with the main symptoms of menopause and, for women who are losing bone density, oestrogen therapy is also the best way to prevent the onset of osteoporosis in 20 years time.
“Too many women are no longer offered HRT. They are instead being prescribed the antidepressant drug Prozac to cope with depression, and Fosimax, a drug to build up bones. Both of these have many side effects,” he adds.
Professor Valerie Beral, director of Cancer Research UK, disagrees and defends the Million Women Study. “Women taking HRT have an increased chance of developing breast cancer. They also have a slight increase in the risk of ovarian cancer, stroke and blood clots,” she says.
She points out that since 2002, Britain’s Medicines and Health care Products Regulatory Agency and its counterparts in Europe and the US have advised that women taking HRT should take it for as short a time as possible and in the lowest possible dose, to relieve symptoms.
However advice from the MHPRA can also be used to support the use of HRT. Tim Hillard, chairman of the British Menopause Society, and a consultant gynaecologist in Dorset, points out that the MHPRA also recommends HRT for most symptomatic menopausal women.
He insists that, for the majority, the benefits will outweigh the risks and, for some, it is crucial. “For women who begin their menopause before 50, the MHRA “strongly recommends” HRT. This group is often overlooked because they are not considered menopausal, yet they will be at higher risk of heart disease and osteoporosis because they won’t produce enough oestrogen naturally to protect themselves from these conditions.” He describes the current situation as a “tragedy” for women.
Dr Sarah Gray, a Truro-based GP who runs a specialist menopause clinic across Cornwall, believes the fall in women taking HRT is partly due to GPs who are reluctant to prescribe it for fear of being blamed for adverse consequences.
“The Committee for the Safety of Medicines wrote to all GPs in December 2003 issuing new guidance for HRT. These stated that it should be given only at the minimum effective dose, for the shortest duration. GPs interpreted this as meaning that it was not to be used if it could be avoided, and that if any woman developed breast cancer it would be the fault of the prescribing GP. Some practices decided not to give out HRT at all.”
She adds: “HRT is not a panacea for all ills. While it may be true that nobody died of a hot flush, some women are unable to function because of the debilitating effects of their flushes, sleep disturbance or mood change. For them, normal life is lost without help. Women who are having a miserable time or who are prematurely menopausal should reconsider.”
The new generation of drugs is also less intrusive, says Prof Studd. “Advances in the methods of delivery mean we can now prescribe HRT so that it enters the body through the skin, via implants, gels and patches. This means there are fewer side effects as it is not processed by the liver, which has occasionally led to blood clots.”
The controversy over HRT looks likely to run and run. It will take another five or 10 years before we can be sure that the drop in both the rates and risk of breast cancer is the direct result of women giving up HRT.
Meanwhile, Tim Hillard thinks the controversy over the Million Women Study has in some ways been positive. “Some women have learnt to manage their symptoms without resource to medication, and if it can be done without drugs, that is good news.”
Comment from Leslie
Here we go again…the 2002 WHI study – the first independent study done on HRT in its 30 years since it was introduced to the market – is being debunked. This is what Big Pharma does – they play a waiting game…sure their sales of HRT took a big hit – but their is enough money in the coffers to wait out the storm and to re-introduce the drug after people’s attentions turn elsewhere and a new market of women enter menopause.
Do not fall prey to this scheme. It is called marketing – it is not done with your health in mind.
Make sure that you read the entire article – follow the link above…they list some alternatives to HRT for reducing menopause discomfort.