New look at dangers in HRT

By REBECCA WALSH, health reporter

An expert health committee will meet today to discuss whether new advice is needed on the use of hormone replacement therapy.

Evidence is mounting that the risks of using HRT outweigh the benefits.

The medication, used to treat the symptoms of menopause, was once touted as a way of preventing heart disease and osteoporosis.

But it has been shown to increase the risk of breast cancer, stroke, clots, heart disease and dementia.

Pharmac figures show the number of women using HRT dropped from 82,400 to 51,900 in the 12 months from June last year, and that trend is expected to continue.

Some women's health advocates question whether HRT should be available at all, but doctors and medical bodies say the risks associated with HRT are now known, and women are making informed choices.

At its meeting today, the Medicines Adverse Reactions Committee, which advises the Ministry of Health, will discuss the latest research on HRT, including a British study published last month which showed women taking combined HRT - a combination of oestrogen and progestogen - were twice as likely as women not using the drug to get breast cancer.

The study, which tracked 1,084,110 women aged between 50 and 64 over 10 years, also found the risks were higher than previously thought and began earlier than doctors had assumed.

Current guidelines recommend using HRT for a limited time in early menopause, and only where the symptoms disrupt quality of life.

Menopause symptoms include hot flushes, headaches, disrupted sleep, irritability, difficulty concentrating and vaginal dryness.

The New Zealand Guidelines Group on HRT, an independent body which assesses research, has just issued its draft revised guidelines to encompass the latest findings.

Added to its list of key messages is that HRT does not improve cognitive function and is associated with an increased risk of dementia.

It also notes the increased risk of breast cancer and says women taking HRT are more likely than those who do not to have abnormal mammograms.

Ministry of Health spokesman Dr Stewart Jessamine said a decision on the need for new advice was weeks away, and if any changes were made doctors would be told before the information was made public.

Christchurch endocrinologist Dr Anna Fenton said most women and doctors were aware of the risks.

She did not believe restricting use of HRT would be helpful.

"I find it useful to say to women, 'If you are going to use it you need to be aware of the risks. Then secondly, knowing that menopause symptoms are around for an average of two to five years, you can still use HRT but get off it before five years when the risk of breast cancer begins to emerge'."

Medical Association chairwoman Dr Tricia Briscoe said the million-women study had reinforced earlier findings and it was important that the guidelines were reassessed.

But she did not expect them to change significantly.

Women's health advocate Sandra Coney said studies now showed the risks in HRT began earlier than thought and she questioned its use, even short-term for hot flushes.

Under a cloud

* The number of New Zealand women using HRT dropped by about 30,500 in the 12 months from June last year.

* Guidelines recommend that use of HRT is confined to early menopause for a limited time.

* HRT has been shown to increase the risk of breast cancer, stroke, clots, heart disease and dementia.