Hormone replacement therapy remains a valuable option for some women despite health scares associated with its use, the American Association for the Advancement of Science meeting in Seattle has been told.
Although there is a slightly increased risk of cancer and heart disease linked to the therapy, the benefits outweigh the risks, the meeting heard yesterday.
A key element of debate was the controversial findings on HRT from the Women's Health Initiative (WHI) clinical trial started by the US National Institutes of Health in 1991.
The trials involved a large study group of more than 160,000 women and are an attempt to find ways of preventing heart disease, breast cancer, colorectal cancer and osteoporosis.
One arm of the study included 16,000 women, half of whom were taking some form of HRT. It hoped to establish whether taking HRT could help reduce the risk of these conditions.
However, the study was halted abruptly in July 2002 after researchers found that combined hormone HRT was actually increasing the risk of heart attacks, breast cancer, strokes and blood clots.
The findings and the unexpected termination of the trial was a bombshell, leaving women concerned about their health and doctors confused about whether to continue recommending HRT, said Prof Susan Johnson, professor of gynaecology at the University of Iowa. "To say that gynaecologists were surprised by the results of the WHI is an understatement," she said.
Use of HRT plummeted after the trial details were released, from 90 million prescriptions in 2002 to about 50 million in 2003. Prof Johnson believes however that "the message has gotten lost" given confusion about the WHI study's intent.
It was established to measure disease prevention, and researchers were surprised when disease enhancement was indicated. The statistical risk was quite low she said, and argued that for some women HRT remained a good option.
HRT did not seem to provide sufficient benefit as a disease prevention measure, but did have value as a way to eliminate hot flushes, mood swings, fatigue and night sweats.
"The risk benefit is very different," she said. Up to 80 per cent of women with these symptoms of menopause had alleviation of symptoms, and she prescribes HRT for these women provided they have no additional risk of heart disease.
"Between five and 10 per cent of women have very severe hot flush and mood swing symptoms," she added. "For some women this is a real problem."
Prof Johnson and other speakers called on women to demand that their doctors take the time to help them balance the risks and benefits of HRT and assist them in coming to a decision on this treatment. Doctors, for their part, must learn more about their patients' risk profile in helping them to make the decision.