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HRT risks exaggerated again

3 February 2014

A recent report in the Canadian Medical Association Journal, published online January 27 2014, from an observational study of more than 30,000 women in Sweden, looking at pancreatitis in women taking HRT and those not taking HRT, has been reported in such a way that yet again may cause women and healthcare professionals to be unnecessarily concerned. The report stated that women who had ever used HRT had a 57% increase in the risk for acute pancreatitis compared with women who had never used HRT.

The authors analysed data from 13,113 women who were current users of HRT at baseline, 3660 past users, and 14,721 women who had never used HRT. Follow-up for this study went through 2010. They found that never-users of HRT had an incidence of acute pancreatitis of 52 cases per 100,000 person-years, while ever-users had an incidence of 71 cases per 100,000 person-years. This translated to a multivariable adjusted risk ratio (RR) of 1.57 (or 57% increase in risk) for pancreatitis among ever-users of HRT compared with never-users. The risk for acute pancreatitis did not differ by current or past use of hormone replacement therapy but seemed to be higher in women who used systemic therapy and those with duration of therapy more than 10 years. The authors suggest that the increased risk for pancreatitis may be related to the increase in triglycerides seen with use of HRT.

Stated possible study limitations include reliance on self-reported use of HRT and lack of information on the preparation, dose, and route of HRT administration. A third limitation was the authors' reliance on the diagnosis reported to the Swedish National Patient Register, although this has been shown to be highly accurate. Finally, the authors may not have accounted for some confounding factors.

Nevertheless, "[u]se of postmenopausal hormone replacement therapy was associated with increased risk of acute pancreatitis," the authors conclude. "If these findings are confirmed by other studies, the risk of acute pancreatitis should be considered when hormone replacement therapy is prescribed."

CMAJ. Published online January 27, 2014. Abstract

It is really disappointing that this report attracted the headline – “Hormone Replacement Associated With Increased Pancreatitis Risk”, when unnecessary importance has been attached to the figures—it is really important to look at absolute figures rather than relative risk. This equates to an extra 19 per 100,000 person years, or 1.9 per 10,000, or 0.19 per 1,000..... These numbers are extremely small and since this is observational, this does not prove causation. The risk benefit analysis for the use of HRT should be kept in mind and the effective treatment of menopausal symptoms which provides great relief and improved quality of life must not be forgotten, not to mention the increased incidence of osteoporotic fractures since there has been less use of HRT. While this is an interesting observation, it will not change my practice nor the advice that I give. Research and studies are important but let’s not distort the findings just to get a startling, eye-catching headline which may give completely the wrong message, leading to unnecessary concern, confusion and ultimately avoidance of very useful, safe therapy.

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