Women advised to weigh up risks, benefits of HRT

Women concerned about the safety of Hormone Replacement Therapy (HRT) should weigh up its risks and benefits in relation to their individual circumstances, health professionals said yesterday.

The advice came after a review of four studies on HRT found that women who took the treatment for five years had a higher risk of breast cancer, stroke and blood clots in the lung.

The review was carried in this week's edition of the medical journal, the Lancet.

Dr Ailís Ní Riain, women's health director at the Irish College of General Practitioners, said there was nothing new in the Lancet study, as it merely reviewed the findings of other studies.

She said she would continue to advise that HRT was safe for short-term treatment of menopausal symptoms. Most symptoms lasted for less than two or three years, she said. But in about one in five cases, the symptoms lasted for up to five years or more.

Dr Ní Riain advised women to discuss the risks and benefits with their GP when their six-monthly prescription was renewed.

In this State, HRT is used by between 10 and 20 per cent of women over 45, to ease menopausal symptoms such as hot flushes and mood-swings. It is also used to reduce the risk of osteoporosis.

The review suggests little difference between the effects of various HRT preparations.

Three of the trials in the analysis studied the effects of combined HRT, and one involved oestrogen only.

It found that, for women in their 50s taking HRT for five years, the greatest risk was of developing breast cancer. Women in their 60s had a higher chance of suffering a stroke or blood clots.

One of the four trials reviewed was by the US Women's Health Initiative. Alarm was caused when this trial was stopped earlier this year because of the perceived risks of HRT.

Dr Máire Milner, consultant obstetrician/gynaecologist at Our Lady of Lourdes Hospital in Drogheda, said HRT had been thought to reduce the risk of heart disease so it was disappointing that the studies did not find evidence of this.

However, the studies did confirm the benefits of HRT in reducing the rate of osteoporosis, she said.

Dr Milner said it was impossible to jump to conclusions about HRT because there was such a large number of treatments, and combinations of treatments.

"The answers are going to be different for every woman, depending on how long she is on it, why she is on it and what her needs are," she said.

Some women may choose to have an increased risk of breast cancer rather than lose the benefits of HRT.

"It's about weighing up the risks and benefits and making a decision. We can only try to interpret the evidence as best we can and let women make up their own minds."

The Irish Medicines Board (IMB) has strengthened the warnings and precautions on the licences of HRT products since the US findings were made public in July.

Dr Joan Gilvarry, IMB medical director, said information leaflets in this State said that the products should not be prescribed for women with a history of breast cancer or with suspected breast cancer.

HRT should be prescribed with caution for women with a family history of breast cancer, she said.

"The findings of the report do not change the overall risk/benefit ratio for short-term use of HRT. However, if women are concerned, they should consult with their doctor or healthcare professionals, as the administration of HRT is evaluated against the ultimate medical benefit for treatment for each individual," Dr Gilvarry said.