Menopause news

HRT - Summarising the risks and benefits.

8 Jan 2009

A recent review by Alastair MacLennan from Adelaide has clarified the uncertainties surrounding the risks and benefits of HRT. Many such reviews have previously been published but this one in particular provides facts and figures in a very clear, concise, helpful way.

Much controversy still surrounds the effect of HRT on the cardiovascular system but it seems that increased risk of heart disease applies if HRT is started some 13-14 years after the menopause, whereas recent evidence suggests that it is more likely to provide cardiovascular benefit if commenced near the menopause, during the "window of opportunity".

The main risk of HRT remains a doubling of the risk of blood clot (venous thromboembolism) but when HRT is used around the time of the menopause, the overall risk is small and so the actual numbers affected are still very small. Further, the risk is thought to be much less with non-tablet route of HRT such as patch or gel, compared to tablet form.

Although many women fear that HRT will cause weight gain, weight gain in users of HRT is similar to non-users.
The risk of breast cancer with HRT continues to cause most concern among both women and their health care providers. Firstly it is now clear that different types of HRT are associated with different risk; the Women's Health Initiative trial showed a reduction of 8 cases of breast cancer per year per 10,000 women in estrogen only users (women who had had a hysterectomy) at 7 years. In women who had not had a hysterectomy and were taking combined HRT (estrogen plus progestogen) the increase in risk only became significant after 7 years when it was 8 cases per 10,000 women per year. Any increase in risk is of concern, but this appears to be a very small risk which, for many women, will be outweighed by benefits.

The control of menopausal symptoms continues to be the main indication for using HRT where improvement in quality of life has been demonstrated. Other benefits include a reduction in osteoporotic fractures, and reduction in diabetes and death.

The important decision of whether or not to take HRT and if so what type, what dose and for how long, must be individualised. There is a move towards using safer types, safer routes and lower doses to minimise risks and side effects while maximising benefits.

This review goes a long way in clarifying these important issues.

Hormone replacement therapy in peri-menopause: a 2008 perspective. Alastair H. MacLennan. Obstetrics, Gynaecology & Reproductive Medicine. Available online 9 December 2008.

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