Edition 20: Hormone Health position statement on HRT

Recent events

An Oxford collaborative group recently published a re-analysis (meta-analysis) of potential breast cancer risks from 24 previously conducted observational studies (old data) in the Lancet online on 30th August 2019.

This resulted in much media activity and an alert which was issued to healthcare professionals from the medical profession’s regulatory body (MHRA)

Key findings

The meta-analysis noted a small but significant duration-dependent risk of increased breast cancer diagnosis with both estrogen alone and combined HRT, the risk with the latter being greater.

The risks appeared to persist even 10 years after HRT had been discontinued.

An increased risk of breast cancer was also found in women with obesity.

There was no evidence of a dosage effect and vaginal estrogen appeared to be without adverse impact.

Putting the findings into perspective

The  overall findings from this meta-analysis are not new and are in keeping with the NICE analysis of the observational breast cancer data and the recommendations in the NICE menopause guideline published in 2015.

The re-analysis did not report on breast cancer mortality; previous long term randomised trials have not shown an increased risk of this.

The re-analysis included less women on estrogen through the skin and a very small number of women on natural “bioidentical” progesterone, both of which are prescribed in most of our patients.

When considering the benefit : risk balance, it must not be forgotten that HRT is highly effective in controlling distressing menopausal symptoms that impact on women’s quality of life.

Also, large studies have shown a significant protective effect against osteoporosis and a reduction in cardiovascular disease and cardiovascular mortality.

There is a significant reduction in all-cause mortality in women who commence HRT below the age of 60.

Hormone Health viewpoint

Research into menopause, HRT and alternatives is generally welcomed to empower women to make fully informed choices about their health.

However, the limitations of any research should be clearly highlighted along with the findings – in this case old data re-analysed, most women not randomised to active or dummy treatment, using older types of HRT.

The findings of these general epidemiological studies do not necessarily apply to women on modern individualised hormone therapy regimens and should be put into context of the overall benefit : risk balance.

We should now be looking forwards not backwards.

Studies such as these highlight how important it is for….

• women to be prescribed optimal HRT regimens given current best evidence which maximise the benefits and minimise risks
• research and development into novel hormonal and non-hormonal treatments to continue.

Next steps

There is no need for you to immediately discontinue your HRT

Your carefully individualised regimen should be reviewed at your next visit by one of the Hormone Health Associates

They will carefully assess the pros and cons of HRT in the context of the findings from the Oxford re-analysis, consider whether it applies to your case

This will empower you to make an evidence based fully informed decision about your menopause care.

References

Statements issued by the British and International Menopause Societies are also attached:

IMS Statement 30.08.19 (PDF, 15KB)

BMS response to Lancet paper on the link between different forms of HRT and breast cancer incidence (Word doc, 151KB)