HRT is an option against coronary disease

 

After years in the wilderness, Hormone Replacement Therapy appears to be attracting the attention of and endorsement from some experts, writes LORNA SIGGINS

STATINS ARE not as effective for women as men in preventing coronary disease, whereas hormone replacement therapy (HRT) is a very realistic option, a British consultant has told a conference in Dublin.

Consultant endocrinologist Dr John Stevenson said he believed it would be “negligent” not to prescribe HRT to women with premature menopause to protect them from coronary illness.

Women who started the menopause below the age of 40 were at “double” the coronary risk, Dr Stevenson said.

He was addressing the annual meeting of the Irish Menopause Society, chaired by its president Dr Barbara O’Beirne, in Dublin earlier this month.

Cardiovascular disease incidence in men – as in a “male politician clutching his chest in the House of Commons” – tended to attract publicity, whereas there was less public awareness of the fact that women were just as vulnerable, Dr Stevenson said.

Risks in women related to genetics, as in relevant family history, ethnic origin, metabolic and lifestyle factors and socio-economic status, he said.

Diabetic women had a four-fold increase in risk of coronary, compared to a two-fold risk in men, but exercise appears to be less important for women, he said.

Survival rates were much improved for women already on HRT who experienced a heart attack – particularly women with early menopause.

Many doctors in Britain were still reluctant to prescribe HRT since the controversy generated by the north American Women’s Health Initiative (WHI) study in 2002.

The 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 Lancet in Britain, had suggested an increased risk of women on HRT dying from breast cancer. As one medical professional had put it at the time, HRT went from being “the universal panacea to a weapon of mass destruction” in the public mind.

These initial statistics were “flawed” and the WHI’s final results in 2003 no longer showed a statistically significant increase in breast cancer risk, Dr Stevenson said. The results had changed again in WHI papers published in 2007 and 2008, he noted.

An impending Danish study on more than 1,000 women, which had been stopped after 10 years when the initial WHI results came out and was then continued for four years, would show a reduction in coronary disease. He said that it would also show no increase in cancer.

Dr Nick Panay, chairman of the British Menopausal Society, said that some two-thirds of women on HRT at the time of the WHI data publication in 2002 came off the medication, and had suffered unnecessarily.

“We now know the limitations of the WHI results, and how a younger cohort of women stands to benefit from the medication,” he said.

Several studies conducted in the US due out in the next year would show “encouraging results” for younger women, given lower doses of HRT which were akin to the body’s natural hormones, Dr Panay said.

A major issue had been the fact that general practitioners who qualified after 2002 in Britain had not been educated about the preventative benefits of HRT, Dr Panay said. He believed that it was “fine” for women who did not want to take HRT, but who were aware of the need for careful lifestyle to be given all the information so they could make an “informed choice”.

Dr Barbara O’Beirne, IMS chair, said that women were “largely unaware” of the impact of the menopause on their future health, and of the many potential gains from lifestyle changes such as exercise, dieting and quitting smoking. She also referred to the “negative stereotyping” of women as they aged.

She expressed concern that many women had been deprived of the HRT option over the past decade – resulting in poor quality of life and a resort in some cases to “unregulated options” which might not be “safe or effective”.

She asked for a show of hands from about 80 doctors present in relation to the number of HRT prescriptions written in the past week – the response amounted to 10 prescriptions.

The IMS meeting was also addressed by Lancashire consultant gynaeocologist and obstetrician Tony Mander.

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