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Another twist in the HRT tale

Arguments about the risks and benefits of hormone replacement have bounced around for 20 years. Now a team of researchers says they have the final answer on whether hormones can prevent disease and chronic conditions.

In the 1990s HRT seemed to be the answer to not only menopausal symptoms such as hot flushes, but a range of chronic diseases — especially heart disease, osteoporosis, dementia and some types of cancers.

But it all went south when the Women’s Health Initiative (WHI) — an American study designed to test this disease prevention aspect — was stopped in 2002 after it became clear that the risks were outweighing the benefits.

When the medical world recovered from the shock, guidelines for the prescription of HRT insisted that it should be used only for menopausal symptom relief in women aged 50-60, and in the lowest dose for the shortest possible time.

Since 2002, it’s often been claimed that the WHI trials were poorly designed. The average age of participants was 63, well past menopause, and critics argued that the risks would be less if HRT was started earlier — at or within five years of menopause. This became known as the ‘timing hypothesis’.

A couple of years ago, a team of researchers from Austria and the US set out to find the definitive answer to this question of disease prevention and to see whether the timing hypothesis stands up.

They pooled the results of the best quality studies on this published between mid-2011 and mid-2016. Recently they announced their findings. 

So can HRT prevent disease? Their answer: maybe, but the risks are too great.

They say that while women using combined therapy (i.e. estrogen plus progestin) may experience benefits such as reduced risks for fractures, diabetes and bowel and rectal cancer, they’re at higher risk of stroke, blood clots, gallbladder disease, urinary incontinence and breast cancer.

Women using estrogen alone apparently have slightly less risk of breast cancer. (Since estrogen can overstimulate the cells of the uterine lining and promote cancer, it’s only used alone with women who’ve had a hysterectomy.) 

This team also dismissed the timing hypothesis, saying that the only studies in this area are either inconclusive or contradictory. 

They concluded that eating healthily, exercising and not smoking are more beneficial than taking hormones. Most of us probably realised that. 

Just to make things interesting, other studies are showing benefits in using HRT to prevent particular conditions. I’ll tackle a few of those for you next month and try to tease out what the difference is. 

For now though, we can assume that the current recommendations on hormone therapy are a good safeguard: it’s useful short-term for reducing the uncomfortable symptoms of menopause, but for the most part it’s not a wise preventative.

Photo Source: Bigstock 

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Wednesday, March 28, 2018 | Rhonda Anderson