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HRT Facts and Myths (09/03 RMD/PD)
Hormone replacement treatment (HRT) has been advised over the last 20
years for women at the menopause who have hot flushes. It has also been
used by women who have had an early menopause and has been advocated for
some women with no or few symptoms on the grounds that it should reduce
bone disease and heart disease.
Many women asked for HRT because they thought it would help them feel
younger.
Myths
1. HRT reduces the chance of getting heart disease. It doesn't. It
increases the chance of this and also increases the chance of stroke and
thrombosis.
2. HRT helps delay osteoporosis. Partially true in that while taking HRT
bone loss in women is reduced but 5 years after stopping HRT there is no
difference in bone loss between women who have had HRT and those that
haven’t, so the delaying effect does not last. Also the main risk time
for osteoporosis is in the late 60's to 80's when HRT cannot be used.
3. HRT will help me feel better after the menopause. Many studies have
shown that HRT is really only effective at helping hot flushes and
dryness during intercourse. It does not improve sex drive, energy levels
or psychological wellbeing any more than placebo unless these symptoms
are related to hot flushes (causing poor sleep) or vaginal dryness.
Furthermore the number of women who complain of these symptoms 1 year
after the menopause is very small.
Facts
1. HRT increases the chance of you getting breast cancer. This was
confirmed in a large study published in 2003 called the Million Women
Study. Women aged 50 to 65 normally have a 1 in 30 chance each year of
getting breast cancer. This increases to 1 in 27 after 5 years of
combined HRT and 1 in 20 after 10 years of use. Looking at the figures
another way, women using combined HRT for some years have an overall
doubling of their risk of breast cancer. Some women have a higher risk
of breast cancer already (mother or sister with breast cancer, periods
starting before age 11, first baby after age 27, being
overweight, drinking moderate amounts of alcohol). For these
people the risks of HRT use for more than 5 years will be higher.
2. HRT increases the chance of a women getting a heart attack, stroke or
thrombosis. These risks are small but they are serious enough for
warnings to be put on literature about HRT treatments.
3. If a woman has had HRT, the increased risks of breast cancer will
have disappeared by the time she has been off it for 5 years.
So who should have HRT?
There are no rules about this and it is best to discuss what your
personal benefits and risks are with a doctor or a nurse.
Patients with an early menopause probably would benefit from having HRT
until the age of 50 without any serious additional risks.
Patients with significant hot flushes disturbing sleep or causing social
embarrassment, or vaginal dryness spoiling their sex life would
certainly benefit from HRT, but the duration of treatment ought to be
initially up to 1 year before a trial off treatment is attempted.
Most patients over the age of 50 should not use HRT for more than a
year. Some patients who may need HRT for longer than this can be
prescribed an alternative which does not contain oestrogen or
progestogen, but this still has an increased risk of breast cancer,
although lower than with conventional HRT.
All women can reduce their bone loss and reduce their risks of heart
disease by not smoking, eating a healthy diet, keeping alcohol
consumption low, and exercising regularly.
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 Whitnash
Medical Centre
110 Coppice Road
Whitnash
Warwickshire
CV31 2LT
Tel: 01926 316711
Fax: 01926 427260
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