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

Is this article an advertisement? I note the authors all have links with the HRT industry.

The claim of a dramatic reduction in hot flushes fails to mention symptom recurrence when the HRT is stopped, and that the largest trial (WHI) showed no benefit on quality of life.

The graphs appear to have been derived from, and give equal weight to, the largest randomised trial and the largest observational study. If the latter were removed and the other eight randomised trials included, the effect on all cause mortality would be in the opposite direction (odds ratio 1.06; 95% CI 0.94 -1.19) (Sanchez et al. 2005).

For the 51 year old woman with hot sweats, HRT provides short term relief. It increases the chance of some diseases, namely cardiovascular disease, strokes and breast cancer and reduces that of others, including osteoporosis, bowel cancer. The exact risk-benefit ratio varies with the woman's prior risk of each disease but the precision of the estimates is insufficient to allow individualised risk assessments.

When they learn that there is no overall improvement in quality of life, and that in the trials overall mortality was increased, most women wisely decide to live with their hot flushes.

Gabriel Sanchez R, Sanchez Gomez LM, Carmona L, Roqué i Figuls M, Bonfill Cosp X. Hormone replacement therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD002229. DOI: 10.1002/14651858.CD002229.pub2.

Competing interests: My mother died of a stroke while taking HRT six months before the Women's Health Initiative trial was suspended because of the increased risk of stroke

28 February 2012
Professor of obstetrics and gynaecology
University of Nottingham
Hucknall Road. Nottingham