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HRT: GPs raise concern about “threatening and unprofessional” template letter for patients “refused” treatment

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6247 (Published 29 October 2019) Cite this as: BMJ 2019;367:l6247

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HRT does not give cardio-protection Re: HRT: GPs raise concern about “threatening and unprofessional” template letter for patients “refused” treatment

HRT does not give cardio-protection

It is wrong to believe that HRT can protect from cardiovascular disease. The reason HRT use fell from 36 million to 12 million in westernised countries was the premature termination of the Women’s Health Initiative (WHI) randomised double-blind control trials.[1-3] The fall in HRT use lead to a fall in breast cancer incidence and mortality, especially from oestrogen-receptor positive tumours.[4-8]

The WHI randomised trial of use of MPA and conjugated estrogen HT in more than 27,000 women was terminated prematurely in July 2002, after 5.6 years, because of increases in breast cancer, venous thromboembolism, coronary heart disease (CAD) and stroke.[2] The estrogen-only WHI observational study enrolled 16,608 women lacking an intact uterus but was stopped on February 2004 after 7.2 years due to increases in strokes and venous thrombosis.[3] Both studies also found increases in all cardiovascular events and gall bladder disease. Progestin/estrogen HT caused increases in “global index” and “probable dementia”. There were no significant benefits from estrogen only HT for “global index” or “all-cause mortality” categories. Global index is a composite and adjusted outcome of CAD, strokes, pulmonary emboli, breast, colorectal and endometrial cancers, hip fractures and mortality.[4-8]

Menopausal steroid withdrawal vasomotor symptoms can be more safely treated by avoidance of precipitants such as smoking, alcohol and common food allergies, and treatment of infections (especially gut candida after antibiotics). Monitored nutritional supplementation to correct common essential nutrient imbalances is safer than continuing to take immunosuppressive, carcinogenic, thrombogenic and psychoactive progestogens and oestrogens.[9,10] It is irresponsible to expect that a single pill can solve complicated medical problems.

HRT is not safe and, like progestogen +/- oestrogen hormonal contraceptives, never has been safe. In fact, GPs have helped to save the lives of many women by refusing to prescribe hormones which increase the risk of breast, ovarian, cervical and other cancers and increase vascular and mental illnesses.

1 Collaborative Group on Hormonal Factors in Breast Cancer. Type and Timing of menopausal therapy and breast cancer risk individual participant meta-analysis of the worldwide epidemiological evidence. Lancet 2019;394 1159-68. :10.1016/S0140-6736(19)31474332
2 Rossouw JE, Anderson GL, Prentice RL. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321-33.
3 The Women's Health Initiative Randomized Controlled Trial. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA 2004;291: 1701-1712.
4 Grant ECG. Price EH. Reduction in mortality from breast cancer: fall in use of hormones could have reduced breast cancer mortality. BMJ 2005; 330:1024.
5 Colditz GA. Decline in breast cancer incidence due to removal of promoter: combination estrogen plus progestin. Breast Cancer Res 2007; 9:108.
6 Ravdin M, Cronin KA, Howlander N, Berg CD, Chlebowski RT, Feuer EJ, Edwards BK, Berry DA. The Decrease in Breast Cancer Incidence in 2003 in the United States. NEJM 2007;356:6.
7 Grant EC. Oral Contraceptive Progestin and Estrogen Use and Increases in Breast, Ovarian, and Endometrial Cancers. JAMA Oncol. 2018 Sep 13. doi: 10.1001/jamaoncol.2018.4146.
8 IARC. Combined estrogen-progestogen contraceptives and combined estrogen-progestogen menopausal therapy. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans 2007; Volume 91.
9 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity and mineral imbalance. J Nutr Environ Med 1998;8:789-91. DOI:10.1080/13590849862131
10 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

04 November 2019
Ellen C G Grant
Physician and medical gynaecologist
Retired
Kingston-upon-Thames. UK