Intended for healthcare professionals

Rapid response to:

Practice Therapeutics

Hormone replacement therapy

BMJ 2012; 344 doi: (Published 16 February 2012) Cite this as: BMJ 2012;344:e763

Rapid Response:

Re: Hormone replacement therapy

Avoiding HRT

Martha Hickey and colleagues’ attempt to resurrect Hormone Replacement Therapy (HRT), by cobbling together selected data for 50 to 59 year olds from two disparate studies, still finds significant increases in breast cancer, strokes and venous thrombotic diseases.1

In reality women aged 50 to 59 cannot have a reduced overall mortality if they take HRT because cancers, vascular diseases and mental diseases are increased in women who take hormones at any age. Mortality was increased 3 fold in women under age 30 if they had ever taken oral contraceptives in the Royal College of General Practitioners study.2

Oral contraceptives were used previously by twice as many women taking oestrogen HRT than non-oestrogen takers in the Nurses’ Health Study. At baseline women who already had cancer were excluded, as were women who had coronary artery disease at each two yearly survey. By 1993 only 9% of the nurses enrolled were still taking HRT, 43% were taking vitamins and nine out of 10 did not believe that HRT was beneficial.3

Similarly HRT gave no overall benefit in the quality of life and doubled mortality from breast and lung cancers in the WHI randomised double blind trial.4,5 The Million Women Study found HRT doubled mortality from ovarian cancer.6

Simple physiological ways of avoiding vasomotor over-reactivity and osteoporosis at the normal physiological event of the menopause include repletion of measurable essential nutrient deficiencies and avoidance of masked food allergies, smoking, alcohol use and contributing medications. 7,8

The message should be that “HRT is dead and needs to be buried”.

1 Hickey M, Elliot J, Davison SL. Hormone replacement therapy. BMJ2012;344:e763

2 Stampfer MJ, Colditz GA. Estrogen replacement therapy and coronary artery disease: a quantitative assessment of the epidemiological evidence.Prev Med 1991 ;20:47-63.

3 Chlebowski RT, Hendrix SL, Langer RD, et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA 2003;289:3243-53.

4 Chlebowski RT, Schwartz AG, Wakelee H, et al; Women's Health Initiative Investigators. Oestrogen plus progestin and lung cancer in postmenopausal women (Women's Health Initiative trial): a post-hoc analysis of a randomised controlled trial. Lancet 2009;374:1243-51.

4 Beral V, Bull D, Green J, Reeves G for the Million Women Study
Collaborators. Ovarian cancer and hormone replacement therapy in the
Million Women Study. Lancet 2007; 369: 1703-1710.

5 Hannaford PC, Iverson L, MacFarlane TV, et al. Mortality among
contraceptive pill users: cohort evidence from Royal College of General
Practitioners’ oral contraception study. BMJ 2010:340:c927.

6 Grant ECG. The pill, hormone replacement therapy, vascular and mood
over-reactivity, and mineral imbalance .J Nutr Environ Med 1998;8:105-116.

7 McLaren-Howard J, Grant ECG, Davies S. Hormone Replacement Therapy
and Osteoporosis: Bone Enzymes and Nutrient Imbalances. J Nutr Environ Med
1998; 8: 129-138

Competing interests: No competing interests

18 February 2012
Ellen CG Grant
physician and medical gynecologist
retired from private practice
Kingston-Upon-Thames, KT2 7JU, UK