HRT: What are the risks?

THE early results of the American study of HRT have not just worried the millions of women taking the treatment. US authorities were so concerned about the findings that they put a stop to the eight-year study involving more than 16,000 women three years early.

But Dr Carolyn Sadler, a woman's health specialist for the Contraception and Sexual Health Service at the Quays, Southampton, welcomed the report and said it has actually brought to light issues about other possible risks of the treatment, which could prove vital to those taking HRT.

One of these risks is heart disease. While Dr Sadler said there were already concerns about HRT and links with breast cancer and thrombosis, she added little was known about how the treatment affected the heart.

"We've known for some time that if a woman takes HRT for more than five years over the age of 50 she does have a very slightly increased risk of breast cancer, but that risk is really very low," she said.

"We've known that HRT very slightly increases the risk of thrombosis. Again, that risk is very low.

"But what came into question a few years ago, we felt that HRT may help heart disease - angina, heart attacks, things like that - and that's really been in question for a number of years now."

Dr Sadler added: "We weren't sure what the situation was. The recent study has helped to clarify that. It looks as though HRT doesn't reduce the risk of heart disease and, in that study, there was a very slight increased risk with HRT.

"The study was very welcome to us because it's helped us to clarify how long women should be taking HRT for.

"But it was based on one particular type of HRT. It's very difficult to say whether all HRTs have the same effect, because there are so many different types."

While it is true that there is an increased risk of breast cancer, stroke and heart disease for those women taking HRT, Dr Sadler said the study was slightly misleading.

"I think the way that it was put across in the media will worry women," she said.

"Even though the percentages that were put across were accurate, the actual figures are very low.

"If you have 10,000 women using HRT over one year, there would be an extra eight cases of breast cancer because of using HRT, an extra seven cases of heart disease and eight extra cases of stroke.

"But death rates didn't increase, so there wasn't any increase of death in taking HRT."

She added: "I think it will cause anxiety in a number of women, perhaps women who are unsure of taking it anyway.

"A lot of women will want to carry on because it dramatically improves their symptoms. Other women may not feel like that.

"The study will help us guide women in their use of HRT. It was a very high-quality piece of research and it's provided very good evidence which will help us to guide patients about how long they should take HRT for."

YOUR QUESTIONS:

WHAT IS HRT?

"When a woman goes through the menopause, she starts to lose, or has a reduced amount of, her own natural hormones and the two main ones are oestrogen and progesterone.

"As a result of that reduction in hormone levels the woman experiences either her periods stopping, or reduced frequency in periods and can also start to complain of certain symptoms such as hot flushes.

"HRT consists of a hormone that replaces the woman's own hormones that she lost and the main one in HRT is oestrogen.

"What it does is it just replenishes the woman's levels of hormone and, as it does that, it manages to counteract the mechanisms which lead to the menopausal symptoms, so that's the main reasons for giving it."

WHY DO WOMEN TAKE HRT?

"I would say that there are basically two reasons for giving it. We've talked about giving it for menopausal symptoms and a lot of women seek advice around that time in their lives because, in a lot of women, it interferes with their quality of life.

"When a woman goes through the menopause there are other effects on different parts of the body, one of which is you can start getting thinning of the bones. You sort of lose some of the mass of bone that you had before.

"The other reason for considering HRT is HRT is known to reduce the risk of thin bones and osteoporosis.

"Women really seek advice about whether they should have HRT for menopausal symptoms, but that's the other category."

WHAT ARE THE RISKS?

"Basically, I think you can classify these in groups. When a woman starts HRT, in some women they can get mild side effects and these need to be discussed with the woman.

"Things like mild breast tenderness and feeling a bit nauseous. The other risks are more serious, but much rarer. If a woman takes HRT for more than five years over the age of 50 she does have a very slightly increased risk of breast cancer.

"HRT also very slightly increases the risk of thrombosis and there is a very slight risk of heart disease with HRT."

WHO IS AT RISK OF AN INCREASED RATE OF HEART DISEASE OR BREAST CANCER ON HRT?

"With breast cancer there are certain risk factors, the main one is family history. We would rarely use HRT in a woman who's had breast cancer. And with heart disease, the risk factors there are smoking, diabetes. All things that are risk factors whether someone is taking HRT or not."

WHAT ARE THE BENEFITS?

"The main one is improving menopausal symptoms. The long-term health gain is reducing osteoporosis risk, but really, to get the full benefit from HRT in that way you need to carry it on for a number of years.

"In time, health professionals may be advising women at risk from osteoporosis to perhaps transfer to another treatment of HRT.

"But it's a benefit to younger women who are at high risk of osteoporosis, women who are at high risk of osteoporosis for other reasons.

"There are some other studies that are not conclusive, that HRT may reduce the risk of bowel cancer, delay the onset of Alzheimer's. There have been some suggestions that it may help in other ways."

IF SOMEONE IS WORRIED ABOUT THE HRT THEY ARE TAKING, WHAT SHOULD THEY DO?

"What women ought to do is, at their next check-up at their GP surgery, just discuss their individual case.

"Why are they taking it, what are their risk factors, how long have they been taking it?

"Women shouldn't just stop taking HRT. The health risks are not high enough to stop taking HRT at all."