Menopause news

Further analysis from WHI

28th April 2006

28 April 2006

Further analysis from WHI

Further conclusions have now been published from the Womens Health Initiative
and the messages are very different from those which received widespread media
attention in 2002.

The increased risk of breast cancer associated with use of HRT which was highlighted by the WHI trial has been analysed further: the increase in invasive breast cancer was only demonstrated in women on combined HRT (oestrogen combined with progestogen) after 5 years who had taken HRT before the study for more than 5 years, with no increase shown in women who had not taken HRT prior to the study. The women on oestrogen only HRT had no increased risk of breast cancer for the duration of the trial, whether or not they had previously taken HRT and in fact had a decrease in risk compared to those taking placebo though the decrease was not significant. It therefore seems that the only group of women who may have an increased risk of breast cancer related to use of HRT are those taking combined HRT for more than 10 years after the age of 50.

The other risk of HRT highlighted by initial reports from the WHI trial was the risk of cardiovascular disease which was some surprise since previously we had believed that HRT use could reduce the risk of cardiovascular disease. The Nurses Health study has, for many years, suggested that HRT protects against cardiovascular disease, and indeed recent analysis showed that both oestrogen only and combined HRT started near the menopause had a significantly reduced risk of coronary heart disease. Further, women starting HRT at least 10 years after menopause had no increase or decrease. Despite initial worrying reports from the WHI trial, analysis now shows that the increase in coronary heart disease with combined HRT in these older women in the trial, only occurred in the first year of treatment and the trend was towards a decrease thereafter, with no overall significant increase. Women in the WHI trial taking oestrogen only had a reduction in coronary heart disease, most marked in the younger age group.

The Womens Health Initiative has also now reported on the trial results of effect of low fat diets on risk of breast and colorectal cancer, and calcium and vitamin D supplements on hip fracture and colorectal cancer. There was no significant reduction in risk of coronary heart disease, stroke, cardiovascular disease, breast or colorectal cancer with low fat diets after 8 years, and no effect of calcium and vitamin D supplements on risk of hip fracture or colorectal cancer but those taking supplements had an increased risk of kidney stones.

This further information from WHI, particularly on risks associated with HRT use, should be widely publicised since it seems that both women and health professionals are worrying unnecessarily about risks of HRT; the risk of breast cancer in fact being small and confined to a very small group of women who take combined HRT for more than 10 years, and there being no overall increase in cardiovascular disease with combined HRT after all and a very likely reduction with oestrogen only and with combined HRT which is commenced in the early menopausal years.

It is time to turn the clocks back! Women can be reassured that the use of HRT for menopausal symptoms is effective, appropriate and safe with the benefits far out-weighing the risks for many women.

For full report from British Menopause Society and references, visit www.the-bms.org/final%20outcome.htm

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