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 Study Confirms No HRT Benefit for Older Women

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PostSubject: Study Confirms No HRT Benefit for Older Women   Fri Sep 21, 2007 12:17 am

Study Confirms No HRT Benefit for Older Women




LONDON, UK -- July 11, 2007 -- New evidence published on bmj.com
today confirms that hormone replacement therapy (HRT) should not be
prescribed to older women who are many years past menopause to help
prevent chronic conditions such as heart disease.



But the authors support the view that HRT is a safe short term
treatment for younger women in early menopause to relieve symptoms and
improve quality of life.



In 2002, the Women's Health Initiative (WHI) trial found that
postmenopausal women taking HRT had more heart attacks and strokes than
non-HRT users. The trial was halted early and millions of women around
the world stopped taking HRT. But scientists now believe that these
risks may only apply to older women who do not normally use HRT.



In 1999, another trial (WISDOM) began to assess the long-term risks and
benefits of HRT after the menopause. This trial was also stopped after
the first WHI results appeared, but the WISDOM findings, published
today, make an important contribution to the body of knowledge about
HRT when it is initiated in older postmenopausal women.



The WISDOM team identified 5,692 healthy women registered at general
practices in the UK, Australia and New Zealand with an average age of
63 years and 15 years after the menopause.



The women who had not had a hysterectomy were split at random into two
groups. One was given a daily dose of combined hormone therapy
(oestrogen and progestogen) and the other group was given a placebo
pill. Women who had had a hysterectomy were split between combined
hormone treatment, oestrogen only and a placebo.



All women were monitored for an average of 12 months and main outcomes
such as cardiovascular disease, osteoporotic fractures, breast cancer
and deaths, were recorded.



There was a significant increase in the number of major cardiovascular
events (angina, heart attack or sudden coronary death) and blood clots
(venous thromboembolisms) in the combined hormone therapy group
compared to the placebo group. However, rates for cerebrovascular
disease, breast or other cancers, fractures and overall deaths were not
significantly different in these two groups.



This study confirms an early increase in thromboembolic and
cardiovascular risk in older women starting hormone replacement therapy
many years after the menopause, say the authors.



It shows that there is no overall disease prevention benefit, and some
potential risk, for women who start hormone replacement therapy many
years after menopause.



The results are also consistent with the early findings of the WHI and
other trials, and support the conclusion that combined oestrogen and
progestogen therapy should not be initiated to prevent cardiovascular
disease in older postmenopausal women.



However, the authors stress that these results cannot necessarily be
applied to younger menopausal women starting hormone replacement
therapy to relieve symptoms such as hot flushes and night sweats. For
these women, recent studies suggest there may be cardiovascular
benefits of taking HRT around the time of menopause. The authors say
that more research is needed to assess conclusively the long term
benefits and risks among these women.



Those helping women make choices about treatment should consider both
the results and limitations of the WHI and WISDOM trials, particularly
those women who may be influenced by the timing of initiation of
hormone replacement therapy, they conclude.



In an accompanying editorial, Dr Helen Roberts at the University of Auckland says that this
study does not change current advice to postmenopausal women. Healthy
women in early menopause are unlikely to face substantially increased
risks when using hormones for a few years, she writes. However, long
term use of hormone replacement therapy to prevent chronic disease is
no longer recommended as the available randomised evidence shows that
the negative outcomes outweigh the positive benefits.
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