Women need to be fully informed about risks of hormone replacement therapy

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7041.1301 (Published 18 May 1996) Cite this as: BMJ 1996;312:1301
  1. Elizabeth H Price,
  2. Helen Kaye Little
  1. Consultant medical microbiologist Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH
  2. Consultant radiologist Bronglais Hospital, Aberystwyth, Dyfed SY23 1ER

    EDITOR,—As women doctors, we were surprised by A J Isaacs and colleagues' suggestion that women doctors are in favour of using hormone replacement therapy themselves and that this predicts wider use by the general population.1 Their statistics hardly support this assertion: of 1514 doctors written to, only 344 confirmed that they currently took such treatment. Women doctors, in common with other women, are subjected to considerable pressure to use hormone replacement therapy, and the risk of serious side effects may be overlooked.

    A 50% increase in the risk of breast cancer is associated with current use of hormone replacement therapy for more than five years.2 Given the already high and rising incidence of this disease in Western populations, this is more frightening to most women than heart disease or osteoporosis, for which hormone replacement therapy is claimed to be beneficial. (The possibility that postmenopausal women taking hormone replacement therapy who develop breast cancer have a better prognosis than those not taking hormone replacement therapy should not be an argument for mass treatment.)

    Suicide has been found to occur in more women taking hormone replacement therapy than expected; not all of these women had a psychiatric history.3 The mood swings of women taking hormone replacement therapy have been analysed4 but may still not be recognised as side effects of a mood altering and possibly addictive drug. This can have implications not only for the women themselves but for those people associated with them, including their families and work colleagues.

    The possible cardiovascular benefits of hormone replacement therapy, which have been frequently quoted, have been questioned.5 Safer ways of decreasing the risk of both heart disease and osteoporosis involve changes in lifestyle, including taking more exercise and having a healthier diet. These should be vigorously advocated, as should stopping smoking.

    The menopause is a normal physiological state, not a disease. Drug treatment should not be given to the general population. Women wishing to make informed choices about hormone replacement therapy, balancing the possible benefits against the dangers and side effects, remain confused by much contradictory information. Those who are concerned about the risks should contact a new organisation, DASH (Doctors Against Abuse from Steroid Sex Hormones), for an alternative approach to the widespread promotion of hormone replacement therapy. The secretary is Dr E Grant, 20 Coombe Ridings, Kingston upon Thames, Surrey KT2 7JU.


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