HRT does not prevent chronic disease after menopause

BMJ 2004; 328 doi: (Published 15 April 2004) Cite this as: BMJ 2004;328:912
  1. Caroline White
  1. London

    Hormone replacement therapy (HRT) should not be used to prevent chronic disease in women who have gone through the menopause. This is the conclusion from the latest trial in the US women's health initiative (WHI) study, published this week in JAMA (2004;291: 1701-12).

    But HRT does have a role in the short term relief of menopausal symptoms, concludes an accompanying editorial (JAMA 2004;291: 1769-71).

    The study, a randomised, double blind, placebo controlled trial of unopposed oestrogen—0.625 mg daily—involved almost 11 000 women aged 50 to 79 years, who were monitored for almost seven years.

    The trial was stopped earlier this year, a year before it was due to end, primarily because an increased risk of stroke and no protection against heart disease had been found (BMJ 2004;328: 602).

    The combined arm of the WHI trial was also terminated early—in July 2002—because of a small increased risk in breast cancer, cardiovascular disease, blood clots, and stroke.

    The oestrogen-only trial has found that there were 376 cases of coronary heart disease and a 39% (276 cases) increased risk of stroke among the women taking oestrogen alone.

    But the hormone also significantly cut the risk of hip fracture by 39% (102 cases). And it cut the risk of breast cancer (218 cases), although this was not significant.

    Oestrogen alone had no significant impact on the risk of pulmonary embolism (85 cases) or bowel cancer (119 cases).

    This translates into an absolute excess risk of 12 additional strokes and six fewer hip fractures per 10 000 person years, say the authors.

    They say that women and healthcare professionals now have “usable risk estimates” to weigh up the pros and cons of taking oestrogen replacement therapy.

    Women should be counselled about the increased risk of stroke “but can be reassured about no excess risk of heart disease or breast cancer for at least 6.8 years of use,” the authors wrote.

    But they concluded: “At present these data demonstrate no overall benefit of [unopposed oestrogen] for chronic disease prevention in postmenopausal women and thus argue against its use in this setting.”

    They say their data support the current recommendations of the US Food and Drug Administration that oestrogen should be used “at the smallest effective dose for the shortest possible time” to relieve menopausal symptoms.

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