Rapid ReviewEvidence from randomised trials on the long-term effects of hormone replacement therapy
Section snippets
What has been learnt from the trials?
Results from randomised trials broadly agree with findings from observational studies for cancer of the breast and colorectum,1, 12 and also for pulmonary embolism13 and fractured neck of femur.14 Moreover, the WHI reported an increasing risk of breast cancer over time,2 corresponding to the increasing risk of breast cancer with duration of use of HRT found in observational studies.12 Both trial and observational data showed that the risk of venous thromboembolism was greater soon after
Implications of the trials for HRT users
Combined HRT, containing conjugated equine oestrogen and medroxyprogesterone acetate, was selected for study in the largest trials2, 3, 10 because these were the most commonly used constituents of HRT in the USA when the trials were set up. At that time, the available evidence suggested that the effects of particular types or combinations of oestrogen or progestagen did not differ materially, with the exception of the greater risk of endometrial cancer with oestrogen-alone than
The future
New results on about 12000 women randomised to oestrogen-alone versus placebo are expected soon, from ESPRIT-UK9 and part of WHI2 (panel 1). The data for combined HRT reviewed here are, however, unlikely to be superceded in the immediate future. Results from WISDOM,10 which is randomising about 22000 healthy women to similar oestrogen/progestagen combinations as WHI, are not expected for a decade. These trials are also studying the effect of HRT on quality-of-life and cognitive function.
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