Letters Premature menopause

Article’s recommendation of HRT is highly questionable

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39563.620266.80 (Published 08 May 2008) Cite this as: BMJ 2008;336:1033
  1. Mark D Lewars, consultant radiologist
  1. 1Southend Breast Unit, Southend University Hospital NHS Trust, Essex SS0 0RY
  1. mark.lewars{at}southend.nhs.uk

    I thought we had laid to rest the myth that hormone replacement therapy (HRT) has a beneficial effect on cardiovascular disease. The American women’s health initiative study, published in 2002,1 which was stopped short because combined HRT increased the risk of breast cancer 2.5-fold, also showed that HRT actually increased stroke and venous thrombosis by 29%.

    The same study showed an increase in bone mineral density and reduction in fractures. Short course HRT has been shown to confer long term benefit,2 so the short course is the only sensible recommendation. It should be given only for severe menopausal side effects, because the risk of breast cancer increases with the duration of treatment.3

    If we add in the higher risk of recall for further investigation after breast cancer screening and cervical screening shown by the million women study, with all the psychological distress that it causes, then it seems irresponsible for Jones et al to recommend combined hormone replacement therapy for 15 years or more.4

    I sympathise with women who have menopausal symptoms, but find it hard to pass by advice that is so contrary to good practice.


    • Competing interests: None declared.


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