Intended for healthcare professionals

Rapid response to:


Benefits and harms associated with hormone replacement therapy: clinical decision analysis

BMJ 2004; 328 doi: (Published 12 February 2004) Cite this as: BMJ 2004;328:371

Rapid Response:

HRT Addiction

The use of progestogens and oestrogens for contraception or
menopausal symptoms decreased from 1975 to 1985 because women over age 35
were warned not to use hormones and older women have higher absolute risks
of venous thrombosis, strokes and heart attacks, especially if they smoke.
Why then were ever more older women given Hormone Replacement Therapy
(HRT) from the mid 1980s until the randomised Women's Health Inititiative
Study results reconfirmed these previously well-known facts?

It may be partly because so many women became menopausal prematurely.
In some HRT studies nearly half of the women had become menopausal before
age 50, often because of surgery. Why has hysterectomy and oophorectomy
been used increasingly and on such a large scale?

The follow-up results from the Walnut Creek Contraceptive Drug Study,
which separated age groups and use of oral contraceptives and/or
menopausal oestrogens, gave some answers in 1977.1 Women aged 18-39 using
oral contraceptives had significantly more hysterectomies, cervical
cancers, fibroids, acute episodes of iron deficiency anaemia, adenomyosis,
pelvic inflammatory disease and ovarian retention cysts.

It seemed illogical that these women should then be given more
progestogens and oestrogens as HRT. One reason is that removal of
endogenous oestrogen and progesterone production causes withdrawal
vasomotor symptoms or mood changes in some women. Withdrawal symptoms can
be even more intense when exogenous hormones are stopped.2 No doubt this
is causing howls of protest from some of the millions of women who have
been recently been advised to stop taking HRT.

In 1997 Doctors against Abuse from Sex Hormones held a conference
together with the British Society for Allergy, Environmental and
Nutritional Medicine. Two women doctors detailed their personal
experiences with HRT and also reviewed the evidence for the adverse mental
and addictive effects of oestrogen and progesterone.2,3 It is our
experience that severe withdrawal symptoms are signs of abnormal
biochemistry, usually deficiencies of zinc, magnesium, copper, B vitamins
and essential fatty acids. These abnormalities can be exacerbated by
taking hormones.

Breast cancer registrations have increased sharply in England and
Wales since 1962, except for the decade between 1975 and 1985 when the use
of hormones decreased.4 Beral and colleagues doubt that HRT acts solely by
accelerating growth of pre-existent breast cancers as no deficit is seen
in past users. They also write that many of the suggested mechanisms of
action of HRT on the breast cannot be substantiated.5 The WHI trial found
nearly twice as many abnormal mammograms after one year in the combined
HRT group. Hormone takers had breast cancers that were larger and at a
more advances stage than in the placebo group. These results indicate that
the increased risk of breast cancer emerges soon after the initiation of
hormone therapy. Estrogen plus progestin may stimulate breast cancer
growth and hinder breast cancer diagnosis 6. Breast cancer is the
commonest cause of premature death in women.

Doctors and women need to have accurate scientific information to be
able to make sensible and safe decisions.

1.Ramcharan S. Pellegrino FA, Ray R, Hsu J-P. The Walnut Creek
Contraceptive Drug Study. A prospective study of the side effects of oral
contraceptives. Vol 111, an interim report. NIH Publication Centre for
Population Research Monograph, Bathesda, 1981.

2.Price EH. Increased risk of mental illness and suicide in oral
contraceptive and hormone replacement therapy in studies. J Nutr Environ
Med 1998; 8:121-127.

3.White M, Grant ECG. Addiction to oestrogen and
progesterone. J Nutr Environ Med 1998; 8:117-120.

4.Grant ECG, Anthony HM, Myhill S, Price E, Steel CM. Breast cancer
and hormone exposure. Lancet 1996 ;348:682.

5. Beral V, Banks E, Reeves, Bull D, on behalf of the Million Women
Study Collaborators. Breast cancer ands hormone replacement therapy: the
Million Women Study. Lancet 2003; 362:1330-1.

6.Chlebowski RT, Hendrix SL, Langer RD, et al, for the WHI
Investigators. Influence of estrogen plus progestin on breast cancer and
mammography in healthy postmenopausal women: the Women's Health Initiative
randomised trial. JAMA 2003; 289: 3243-53.

Competing interests:
None declared

Competing interests: No competing interests

19 February 2004
Ellen C G Grant
physician and medical gynaecologist
20 Coombe Ridings, Kingston-upon-Thames, Surrey, KT2 7JU, UK.