No minimal benefits of HRT can justify increasing cancers and numerous serious illnesses
In the WISDOM HRT trial, overall health related quality of life
measures were reduced at 4 and 14 weeks of HRT use rather than increased
(Table 3).1 Data was unavailable for 2 out of 3 women when the trial was
terminated at a year but there were 6 deaths in HRT users compared with 2
in placebo takers. Twice as many HRT takers had stopped by 40 weeks,
mostly because of large increases in endometrial bleeding (hazard ratio
13.4) and breast tenderness. The authors already reported about a seven-
fold increase in major cardiovascular and venous thromboembolic events.2
Even so, they now want the current HRT guidelines revisited.1
In the light of these results, it would be irresponsible to think
that any use of HRT is justifiable. How can minor improvements in a few
symptoms such as flushing compare with the continued use of highest level
carcinogens? There have been huge increases in breast and other cancers as
hormone use has increased over the last 60 years.3,4
There were no differences in most of the 28 symptoms listed at one year
because most of the women with troublesome side effects had already
stopped. A much vaunted reduction in hot flushes, night sweats, insomnia
and aches and pains was presumably due to HRT steroid suppression of
vasomotor activity in the remaining women.
The authors do not distinguish between the effects of different dose
combinations on symptoms. Conjugated equine oestrogens given as a 0.625 mg
dose plus 2.5 mg of medroxyprogesterone acetate reduced vaginal dryness
but increased vaginal discharge and endometrial bleeding. 38% of HRT
takers were unblinded because of bleeding compared with 4% of placebo
takers. The progestogen dose was increased to 5 mg to reduce the oestrogen
balance and bleeding but the risk of vaginal dryness and depression would
increase.
Basic physiological hormonal mechanisms do not alter however data is
manipulated in epidemiological studies.5 We reported in 1968 that
oestrogens tend to elevate mood and sexual interest while progestogens can
cause depression and loss of libido. These effects coincide with lower and
higher monoamine oxidase (MAO) activities in normal and treated cycles.6
More oestrogenic progestogen-dominant combinations could induce sudden
changes in sexual thoughts including violence and aggression, especially
in the combinations with marked endometrial vascular changes. Increases in
suicides and violent deaths have been shown in HRT users.7 Such mental
changes are not a sign of improved sexual health.
Vasomotor symptoms such as flushing have many causes including
adverse reactions to tobacco, alcohol and coffee, toxic metal
sensitivities, and food and chemical allergies which are increased by
nutritional deficiencies (the latter may be associated with the Pill, HRT
and hormonal fertility treatments). They are warning symptoms and can be
more safely treated by avoidance of precipitants and by monitored
nutritional supplementation than by taking immunosuppressive,
carcinogenic, thrombogenic and psychoactive steroids. It is irresponsible
to continue to promote HRT or to expect that a single pill can solve
complicated medical problems.
1 Welton AJ, Vickers MR, Kim J et al. Health related quality of life
after combined hormone replacement therapy: randomized controlled trial.
BMJ 2008;337:a1190
2 Vickers MR, MacLennan AH, Lawton B, et al. Main morbidities
recorded in the women’s international study of long duration oestrogen
after menopause (WISDOM): a randomised controlled trial of hormone
replacement therapy in postmenopausal women. BMJ 2007;335:239.
3 IARC. Combined estrogen-progestogen contraceptives and combined
estrogen-progestogen menopausal therapy. IARC Monographs on the Evaluation
of Carcinogenic Risks to Humans 2007; Volume 91
5 Grant ECG. Hormone balance of oral contraceptives.
J Obstet Gynaecol Br Commonw 1967;74:908-18.
6 Grant ECG, Pryce-Davies J. Effect of oral contraceptives on
depressive mood changes and on endometrial monoamine oxidase and
phosphatases. BMJ 1968 28; 3:777-780.
7 Price EH. Increased risk of mental illness and suicide in oral
contracrptive and hormone replacement therapy studies. J Nutr Environ Med
1998;8:121-128.
Rapid Response:
No minimal benefits of HRT can justify increasing cancers and numerous serious illnesses
In the WISDOM HRT trial, overall health related quality of life
measures were reduced at 4 and 14 weeks of HRT use rather than increased
(Table 3).1 Data was unavailable for 2 out of 3 women when the trial was
terminated at a year but there were 6 deaths in HRT users compared with 2
in placebo takers. Twice as many HRT takers had stopped by 40 weeks,
mostly because of large increases in endometrial bleeding (hazard ratio
13.4) and breast tenderness. The authors already reported about a seven-
fold increase in major cardiovascular and venous thromboembolic events.2
Even so, they now want the current HRT guidelines revisited.1
In the light of these results, it would be irresponsible to think
that any use of HRT is justifiable. How can minor improvements in a few
symptoms such as flushing compare with the continued use of highest level
carcinogens? There have been huge increases in breast and other cancers as
hormone use has increased over the last 60 years.3,4
There were no differences in most of the 28 symptoms listed at one year
because most of the women with troublesome side effects had already
stopped. A much vaunted reduction in hot flushes, night sweats, insomnia
and aches and pains was presumably due to HRT steroid suppression of
vasomotor activity in the remaining women.
The authors do not distinguish between the effects of different dose
combinations on symptoms. Conjugated equine oestrogens given as a 0.625 mg
dose plus 2.5 mg of medroxyprogesterone acetate reduced vaginal dryness
but increased vaginal discharge and endometrial bleeding. 38% of HRT
takers were unblinded because of bleeding compared with 4% of placebo
takers. The progestogen dose was increased to 5 mg to reduce the oestrogen
balance and bleeding but the risk of vaginal dryness and depression would
increase.
Basic physiological hormonal mechanisms do not alter however data is
manipulated in epidemiological studies.5 We reported in 1968 that
oestrogens tend to elevate mood and sexual interest while progestogens can
cause depression and loss of libido. These effects coincide with lower and
higher monoamine oxidase (MAO) activities in normal and treated cycles.6
More oestrogenic progestogen-dominant combinations could induce sudden
changes in sexual thoughts including violence and aggression, especially
in the combinations with marked endometrial vascular changes. Increases in
suicides and violent deaths have been shown in HRT users.7 Such mental
changes are not a sign of improved sexual health.
Vasomotor symptoms such as flushing have many causes including
adverse reactions to tobacco, alcohol and coffee, toxic metal
sensitivities, and food and chemical allergies which are increased by
nutritional deficiencies (the latter may be associated with the Pill, HRT
and hormonal fertility treatments). They are warning symptoms and can be
more safely treated by avoidance of precipitants and by monitored
nutritional supplementation than by taking immunosuppressive,
carcinogenic, thrombogenic and psychoactive steroids. It is irresponsible
to continue to promote HRT or to expect that a single pill can solve
complicated medical problems.
1 Welton AJ, Vickers MR, Kim J et al. Health related quality of life
after combined hormone replacement therapy: randomized controlled trial.
BMJ 2008;337:a1190
2 Vickers MR, MacLennan AH, Lawton B, et al. Main morbidities
recorded in the women’s international study of long duration oestrogen
after menopause (WISDOM): a randomised controlled trial of hormone
replacement therapy in postmenopausal women. BMJ 2007;335:239.
3 IARC. Combined estrogen-progestogen contraceptives and combined
estrogen-progestogen menopausal therapy. IARC Monographs on the Evaluation
of Carcinogenic Risks to Humans 2007; Volume 91
4 Grant ECG. Increases in breast cancer incidence
http://bmj.com/cgi/eletters/328/7445/921#55298, 1 Apr 2004.
5 Grant ECG. Hormone balance of oral contraceptives.
J Obstet Gynaecol Br Commonw 1967;74:908-18.
6 Grant ECG, Pryce-Davies J. Effect of oral contraceptives on
depressive mood changes and on endometrial monoamine oxidase and
phosphatases. BMJ 1968 28; 3:777-780.
7 Price EH. Increased risk of mental illness and suicide in oral
contracrptive and hormone replacement therapy studies. J Nutr Environ Med
1998;8:121-128.
Competing interests:
None declared
Competing interests: No competing interests