HRT safe for healthy women entering menopause

This is the conclusion of the First Global Summit on menopause-related issues held in Zurich in March this year. The summit was attended by international experts on menopausal medicine, who reviewed the evidence on the safety, risks and benefits of HRT in the first few years of menopause. They looked at four main areas of controversy: cardiovascular health, breast issues, cognition, and bone issues.

Their review will be presented at the World Congress on Menopause in Madrid in May 2008.

Background - the WHI Study

Hormone replacement therapy (HRT) use declined after the Women's Health Initiative (WHI) study results were published in 2002. Initial results from the WHI study seemed to show that women taking HRT were at greater risk of breast cancer and heart disease, and this study had a dramatic effect on public perceptions and confidence in the use of HRT. However, since the first WHI information was released, it has become apparent that the study group was not completely representative of women taking HRT, and was characterized by a high incidence of several important risk factors, unusual in younger women around their menopause. For example:

The average age of women in the WHI study was 63 years of age, which is a decade older than the age at which most women begin taking HRT

Of women randomly assigned in the WHI study, 36% had hypertension, 49% were current or past smokers, and 34% were clinically obese, which are all factors which would contribute to increased health problems.

In addition, the reporting of the study did not make clear that different HRTs have different risks and benefits, but most importantly the most recent reports from WHI have clearly shown that the age at which HRT is started is critical. Most experts now agree that the fall-out from the initial WHI results has led to public concern about HRT use, which is not justified by the clinical evidence.

The Global Summit was called to review the current evidence, and to review the risks and benefits of using HRT for women in early menopause. Forty of the world's leading menopause experts met to review public perceptions, risks and benefits. Their main conclusions were:

Cardiovascular issues

Combined oestrogen and progesterone do not increase chronic heart disease risk in healthy women aged 50-59; oestrogen alone actually decreases risk in this group.

Breast cancer

Certain types of HRT (combined oestrogen and progesterone) can lead to a slightly increased risk of breast cancer. However, this is minimal in relation to other breast cancer risk factors. Women with no prior use of oestrogen alone actually had no increased risk for breast cancer in the WHI. Short-to-medium term use of oestrogen-only HRT does not show this effect. The key message is that each woman should discuss her general health, and risk factors such as a family history, smoking, etc., with her own doctor, but generally healthy women (i.e. with no other breast cancer risk factors) entering the menopause should have no fears.

Bone

HRT is effective in maintaining bone health in 50 to 59-year-old postmenopausal women.

Cognition

HRT does not impair cognition in healthy women aged 50-59, and may even delay the decrease of cognitive functions in this group.