Hormone replacement therapy provides no overall benefit on quality of life
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1785 (Published 14 March 2012) Cite this as: BMJ 2012;344:e1785
- Jim G Thornton, professor of obstetrics and gynaecology1
- jim.thornton{at}nottingham.ac.uk
The claim of a dramatic reduction in hot flushes fails to mention that symptoms recur when hormone replacement therapy (HRT) is stopped and that the largest trial (Women’s Health Initiative) showed no benefit on quality of life.1
The graphs seem to have been derived from, and give equal weight to, the largest randomised trial and the largest observational study. If the observational study were removed and the other eight randomised trials included, the effect on all cause mortality would be in the opposite direction (odds ratio 1.06, 95% confidence interval 0.94 to 1.19).2
For the 51 year old woman with hot flushes, HRT provides short term relief. It increases the chance of some diseases—cardiovascular disease, strokes, and breast cancer—and reduces that of others, including osteoporosis and bowel cancer. The exact risk-benefit ratio varies with the woman’s risk of each disease, but the precision of the estimates is insufficient to allow individualised risk assessments.
When women learn that HRT provides no overall improvement in quality of life, and that in the trials overall mortality is increased, most wisely decide to live with their hot flushes.
Notes
Cite this as: BMJ 2012;344:e1785
Footnotes
Competing interests: JGT’s mother died of a stroke while taking HRT six months before the Women’s Health Initiative trial was suspended because of the increased risk of stroke.