A wasted decade: How one HRT scare has 'caused thousands of women 10 years of needless suffering'
07:21 GMT, 22 May 2012
'Wasted decade': A panel of experts believe the 2002 HRT scare has denied thousands of women the relief that hormone replacement could offer
Thousands of women have had a ‘wasted decade’ of suffering since the HRT scare, according to an international panel of experts.
A major reassessment of the research into hormone replacement therapy has concluded that menopausal women were the victims of ‘mass fear’ generated by findings from ten years ago.
Many of the conclusions reached by the 2002 study, including the raised risk of breast cancer, have now been overturned.
British doctors are calling for the rules on prescribing HRT to be rewritten, allowing a new generation to benefit from bone protection and improved quality of life.
At present, women in their 50s are told to use hormone replacement therapy drugs for the shortest period of time that is possible and not for longer than five years.
Some younger doctors have never prescribed HRT because they wrongly believe the risks of the treatment outweigh the benefits, it is claimed.
The new analysis of the evidence by leading experts – including clinicians from the US National Institutes of Health who worked on the original Women’s Health Initiative study – is published in a series of articles in Climacteric, the journal of the International Menopause Society.
The scare began in 2002, when the WHI study was halted three years early because researchers claimed women using HRT were at higher risk of breast cancer, heart disease and strokes.
This contradicted previous research which suggested oestrogen guarded against heart problems. Afterwards, an estimated one million women in the UK stopped taking the treatment – which was used by two million at the height of its popularity.
HRT is normally prescribed to menopausal women in their 50s to combat symptoms such as hot flushes and mood changes, although it also protects bones.
But in the WHI study, HRT was also given to women in their 60s and 70s who had gone through the menopause years earlier. The average age of the women in the study was 63 years.
Fresh analysis of the data found the extra health risks only applied to the older patients, who would not normally use HRT.
The chairman of the British Menopause Society has claimed that for the majority of women, the benefits of HRT far outweigh the risks
Indeed, the drug was shown to cut heart attacks among women in their 50s, who were at no higher risk of strokes and had a lower risk of death from any cause compared with those not taking HRT.
The reappraisal found that the evidence has changed over the past ten years, and there is now a consensus that the absolute risks for a woman of taking HRT in her 50s is ‘extremely low’, according to Climacteric joint editor-in-chief Dr Nick Panay.
TIMELINE: THE HRT SCARE
2002: US doctors publish early findings from Women’s Health Initiative (WHI) study which is stopped because of safety fears. It states that long term use of HRT is linked to higher risk of heart disease, strokes and cancer.
2003: British experts at Cancer Research UK publish their Million Women Study (MWS) which claims HRT users are at double the risk of breast cancer. An estimated one million British women stop taking it.
2004: Second MWS report says the breast cancer risk for women in their 50s using HRT for five years is 50 per cent higher. UK doctors are advised by the MHRA regulatory body to prescribe the ‘lowest effective dose for shortest possible time’, with annual reviews.
2007: WHI researchers publish new analysis showing women on HRT are not more at risk of heart problems – and could be less at risk than non-users. MHRA reiterates its advice, and says HRT should only be used to prevent osteoporosis in women who cannot take other medicines. Another WHI analysis shows women in their 50s taking HRT have healthier arteries as a result, which could protect them against heart disease.
2011: Fourth MWS report says the increased risk of breast cancer from HRT reverts to level of non-users two years after stopping it.
2012: Reappraisal by international experts says HRT has ‘low risks’ and regulatory bodies must update advice about use.
He added: ‘The benefits far outweigh the risks for the majority of women choosing to use it.
‘We need the official authorities to recognise this and issue updated recommendations about HRT use which are less draconian.
‘This has been a wasted decade for thousands of women whose quality of life could have been improved. The big scandal is their risk of osteoporosis could have been reduced.’
Dr Panay, who is chairman of the British Menopause Society, added that the absolute risks of breast cancer for women using HRT were low.
Around one extra case occurs per 1,000 women taking HRT for one year and the risk only starts rising after seven years of use, he said.
He went on: ‘HRT is safe for women who need it in their late 40s and early 50s. The WHI study gave it to older women who would not normally take it.’
He said ‘mass fear’ was generated among women and doctors, and an ‘entire generation of younger doctors has never prescribed HRT’. WHI study leader Dr Robert Langer, of the Jackson Hole Center for Preventive Medicine in Jackson, Wyoming, said lessons had been learned.
He added: ‘Overgeneralising the results from the women who were – on average – 12 years past menopause to all postmenopausal women has led to needless suffering and lost opportunities.
‘Sadly, one of the lessons from the WHI is that starting HRT ten years or more after menopause may not be a good idea, so the women who were scared away over the past decade may have lost the opportunity to obtain potential benefits.’
WHI researcher Professor Matthew Allison, of the University of California, San Diego, said: ‘Being obese, not exercising or excess alcohol consumption confer higher absolute risks for breast cancer than HRT use.’
Current medical advice in the UK states that HRT should be offered only to women with serious menopausal symptoms and taken for the shortest time possible.
'THE MENOPAUSE HAS BEEN THE WORST TIME OF MY LIFE'
Mother of two Teresa Bunby, 52, has been going through the menopause for five years and has suffered ‘horrible’ symptoms.
But she refuses to take HRT even though she knows it could have eased her depression and hot flushes.
For her, the thought of taking drugs is a step too far because she has heard that HRT is linked to health problems including cancer and weight gain.
She said: ‘The menopause started when I was 47 and it’s been horrendous, the worst time of my life. I often feel down and depressed.
‘But I believe HRT causes breast cancer and other problems, and it makes you put weight on.
‘I decided to try to do it without drugs because I was also told the symptoms come back when you stop taking it. My GP said if I could, I should try doing without HRT.’
Mrs Bunby, from Hull, had a breast cancer scare two years ago which made her even more determined to avoid hormone treatment.
‘I decided I couldn’t put anything alien in my body that might increase the risk – it’s just not worth it,’ she added.
The divorcee, who helps look after her two grandsons, said she can manage to care for them despite her symptoms often making her feel ill.
She added the new research is unlikely to change her opinion of HRT. ‘It’s been five years and having got this far, I’m going to stick it out. It’s come too late to change my mind.’