Hard choices on hormone replacement therapy

When I was at medical school, hormone replacement therapy was not just the treatment of choice for the flushes and sweats of menopause. It was also thought to reduce the risk of heart attacks, strokes, dementia, colon cancer, bone and even teeth loss.

Yet over the past few years new research has made many doctors reluctant to prescribe HRT in the longer term. Their concern stems mainly from a study conducted during the US Women’s Health Initiative (WHI), a government-funded project to investigate the health of postmenopausal women.

The large, randomised, placebo-controlled trial was stopped early, in 2002, when researchers became concerned by the increased rate of heart attacks and strokes in the HRT group, compared with those taking the placebo. HRT did seem to reduce the rate of bone fractures and colon cancer, but the investigators decided that the adverse effects outweighed the beneficial ones. In the UK, research projects such as the Million Women Study have also found HRT to prompt side-effects such as breast and ovarian cancers.

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