HRT risks outweigh benefits for chronic disease prevention, research confirmsBMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5885 (Published 02 October 2013) Cite this as: BMJ 2013;347:f5885
Hormone replacement therapy (HRT) is not recommended for chronic disease prevention as the risks outweigh the benefits, further follow-up from the large Women’s Health Initiative trials has found.1
The studies included more than 27 000 postmenopausal women aged between 50 and 79 who were enrolled at 40 centres in the United States.
One trial was for women with an intact uterus who received either conjugated equine oestrogens (0.625 mg a day) plus medroxyprogesterone acetate (2.5 mg a day) or placebo for a median 5.6 years.
The second trial was for women who had undergone a hysterectomy who received conjugated equine oestrogen alone or placebo for a median 7.2 years. The women were followed for an additional six to eight years until 30 September 2010.
The latest results, reported in the journal of the American Medical Association, JAMA, show that among the women given oestrogen plus progesterone there were 206 cases of invasive breast cancer, compared with 155 in the placebo group (hazard ratio 1.24 (1.01 to 1.53)). These women also had more cases of coronary heart disease, but the difference was not significant (196 versus 159; hazard ratio 1.18 (95% confidence interval 0.95 to 1.45)). Risks were also increased for stroke, pulmonary embolism, gallbladder disease, urinary incontinence, and dementia in those aged 65 and older.
Benefits included decreased hip fractures, diabetes, and vasomotor symptoms. Most of the risks dissipated after the intervention ended, although the risk of breast cancer persisted during the follow-up.
For women who had undergone a hysterectomy who only received oestrogen, the benefits and risks during the intervention phase were more balanced, with increased risks of stroke and venous thrombosis, reduced risk of hip and total fractures, and a non-significant reduction in breast cancer. Among women given oestrogen alone, the results were more favourable among younger women (aged 50-59) for all cause mortality and myocardial infarction.
The authors wrote, “Even though hormone therapy may be a reasonable option for management of moderate to severe menopausal symptoms among generally healthy women during early menopause, the risks associated with hormone therapy, in conjunction with the multiple testing limitations attending subgroup analyses, preclude a recommendation in support of conjugated equine oestrogen use for disease prevention even among younger women.”
Cite this as: BMJ 2013;347:f5885