Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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No benefits of HRT
- Ellen C G Grant (11 February 2005)
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HRT and natural law
- Alan W Fowler (16 February 2005)
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Ellen C G Grant, physician and medical gynaecologist Kingston-upon-Thames, KT2 7JU, UK
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There are no benefits from taking HRT. The conclusion of the Women’s Health Initiative WHI investigators, Hays and colleagues, was that, “In this trial in postmenopausal women, estrogen plus progestin did not have a clinically meaningful effect on health-related quality of life”.1 Why do Crawford and Langhorne think that more HRT trials are needed? They write that perceptions on youthfulness, attractiveness, and skin tone have not been adequately studied.2 Do women “look good” when they develop breast, endometrial, ovarian, liver and skin cancers, migraine, strokes, heart attacks, thrombosis, pulmonary emboli, mental diseases and auto- immune diseases. There is no “possibly increased risk of breast cancer” about the evidence from major trials. Less than 12 months use of most HRT formulations increases breast cancer risk; quantified at 45-63 per cent in the Million Women Study (MWS), which also found current use of HRT doubled the risk of breast cancer and increased breast cancer fatalities by at least 22 per cent.3 In both the MWS and the US WHI studies progesterone HRT caused 4 times more breast cancer than oestrogen-only HRT. 10 years use of progesterone or oestrogen-only HRT trebled breast cancer risks compared with 5 years of use. HRT increases breast growth and vascularity making these cancers particularly difficult to diagnose by mammography.4 There have been dramatic increases in breast cancer incidences since the 1960s, especially in women of hormone-taking ages, matching changes in hormone use.5,6 It is now 43 years since the BMJ published our first paper with evidence for the headache-causing effect of a progestogen and oestrogen oral contraceptive. 7 How many more women have to be sacrificed to save the face of hormone pushers and their apparently unlimited research funds? Why on earth (certainly not in heaven) are further trials needed and why should HRT continue to be used at all? Knowledgeable women refuse to join the huge toll of victims of hormone promotion. 1. Hays J, Ockene J, Brunner RL, Kotchen JM, Manson JE, Paterson RE, et al. Effects of estrogen plus progesterone on health related quality of life. N Engl J Med 2004; 384: 1839-54. 2 Crawford F, Langhorne P. Time to review all the evidence for hormone replacement therapy. BMJ 2005;330:345 (12 February), doi:10.1136/bmj.330.7487.345 3 Beral V, Banks E, Reeves G, Bull D, on behalf of the Million Women Study Collaborators. Breast cancer and hormone-replacement therapy: the Million Women Study. Lancet 2003; 362: 1331. 4 Chlebowski RT, Hendrix SL, Langer RD, et al, for the WHI Investigators. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative randomised trial. JAMA 2003: 289: 3243-53. 5 Grant ECG. Increases in breast cancer incidence http://bmj.com/cgi/eletters/328/7445/921#55298, 1 Apr 2004 6 Grant ECG. Re: Rapid Responses; Authors' reply. http://bmj.com/cgi/eletters/328/7445/921#55843, 6 Apr 2004 7 Mears E, Grant ECG. "Anovlar" as an oral contraceptive. BMJ 1962; 2: 75-7 Competing interests: None declared |
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Alan W Fowler, Retired orthopaedic surgeon BRIDGEND CF31 1QJ
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HRT and natural law In their commentary on the association between hormone replacement therapy and stroke, Crawford and Langhorne ¹ emphasize the need for clear guidelines for the use of HRT which can be tailored to the individual patient. They also admit that opinions vary about whether the menopause is a deficiency disease or a rite of passage. However I suggest that no doctor who believes that the menopause is a disease will be able to give clear and rational advice on this subject. There is no justification for regarding a physiological menopause as a disease. The medical profession has had many opportunities to learn from experience that any attempt to treat a physiological condition will be futile. There are no exceptions to the rule that attempts to change the function of a healthy body in a natural environment are likely to be harmful. The HRT debacle is the most recent example of the operation of this fundamental law of nature. Another example was the attempt to treat the physiological ‘anaemia’ of pregnancy. When it was found. that healthy pregnant women had haemoglobin concentrations of around 10g/dl they were regarded as anaemic and given iron. When it was possible to measure blood volume it was revealed that in pregnancy the blood volume is increased by up to 50% whereas the red cell volume is increased by only half this amount. The increased blood volume was clearly designed to fill the increased vascular bed and the lower haemoglobin concentration served to make the blood less ‘sticky’ and facilitate blood flow through the placenta and the compressed pelvic veins. However, in spite of these findings, many pregnant women continued to be given iron until clinical studies revealed a strong association between raised haemoglobin and low birth weight, premature delivery and still births. Why are we so prone to treating physiological conditions? Why did we need to be shown that giving iron routinely to young babies has a negative effect on growth? Why did we go along with suggestions that teething might explain a fretful baby? And why did we not publicise more vigorously the dangers of baby walkers? Will we ever learn to respect the natural law? Alan W Fowler 1 Crawford F, Langhorne P. Commentary: Time to review all the evidence for hormone replacement therapy. BMJ 2005;330:345 Competing interests: None declared |
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