'Confident advice' needed to ease fears over HRT

WOMEN SHOULD be given “confident advice” which allows them to make an “informed choice” about using hormone replacement therapy (HRT) to relieve symptoms of menopause, Irish Menopause Society (IMS) president Dr Barbara O’Beirne has said.

“It is time to rethink the whole area of HRT and give women confident, reliable advice,” Dr O’Beirne told the Irish Menopause Society’s (IMS) annual symposium in Dublin at the weekend.

While it was “very hard” for doctors to “reason away fear” generated by the 2002 controversy over the drug, HRT could provide a “window of opportunity” for women in certain categories with certain symptoms, Dr O’Beirne noted.

Recent adverse media reports about HRT “couldn’t have come at a worse time” for women with premature ovarian failure which led to early menopause, Dr Nick Panay of the West London Menopause Centre told the conference.

He recalled a colleague’s comment that after the risks of breast cancer were highlighted in the 2002 Women’s Health Initiative (WHI) study in north America, HRT had gone from being “the universal panacea to a weapon of mass destruction” in the public mind.

The 2002 WHI study on 10,000 women on HRT had reported an increased risk of breast cancer, heart attacks and strokes, but fewer cases of bowel cancer and hip fractures. The subsequent Million Women Study, published in 2002 in The Lancetin Britain, had suggested an increased risk of women on HRT dying from breast cancer.

Dr Panay said that HRT use for early onset of menopause offered “benefits rather than risk”, and the majority of his patients with premature ovarian failure – which he prefers to call premature ovarian dysfunction – were able to avail of a variety of preparations, depending on their individual symptoms.

Some 13 per cent of cases of early menopause due to premature ovarian failure were among women under 20, and the worst symptoms of menopause, such as hot flushes, sleeplessness and depression, were among women in the 30-35 year age range.

HRT could be of benefit to these women, yet after the media controversy over the WHI findings, there had been a marked reduction in the use of it by early menopausal women.

Carmel Malone of NUI Galway (NUIG) said that HRT “may not be the poison that we thought it was”, and the 2002 WHI study had not been designed to identify breast cancer risk. A subsequent WHI trial which had not received so much publicity had shown a decreased risk of breast cancer in women taking “estrogen-only HRT”.

Ms Malone said that the estrogen-only HRT option would appear to be preferential to the combined HRT drug, and there was a need to take the patient’s entire characteristics into the equation.

Dr Michael O’Connell of the Coombe Hospital in Dublin said that correct information was vital for women. The 2002 WHI study had “really changed thinking” on HRT, and since then the management of the menopause had moved increasingly away from hospitals and into the primary care sector.

Dr Shirley McQuade, medical director of the Well Woman Centres in Dublin, noted that statistics recorded in the clinics from 2001 had shown a dramatic decrease in HRT use.