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Hormone Replacement Therapy -
Study Comments
Researchers writing
in the Journal of the British
Menopause Society say "Many women have been denied or have
discontinued HRT because of the fear of risks, which may not
have been put in perspective or fully understood."
Davey DA. Hormone
replacement therapy: time to move on? J Br Menopause Soc. 2006
Jun;12(2):75-80.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=16776859&
Hormone replacement
therapy: time to move on?
The risks and benefits of hormone replacement therapy (HRT) need
to be put in perspective. In the analysis of clinical trials,
emphasis is often placed on relative risks, statistical
significance and 95% confidence intervals, whereas, from a
clinical perspective, more may be gained from a consideration of
the absolute and attributable risks of therapy.
The Council for International Organizations of Medical Sciences
recommended that the frequency of adverse events be categorized
as 'rare' if less than 1/1000 but more than 1/10,000, and as
'very rare' if less than 1/10,000. In the analyses of the
Women's Health Initiative (WHI), the attributable risks were
'appreciable' (i.e. more than 1/1000) only in women aged over 70
years, with the exception of the risks of venous thromboembolism
and stroke. The women in the WHI trial do not represent the
relatively younger, healthy, postmenopausal women most commonly
prescribed HRT, who are probably at much lower risk.
Moreover, the WHI trial did not take into account the benefit of
relief of menopausal symptoms, which is, for many women,
paramount and outweighs the 'rare' long-term risks. Age may be a
useful guide to risks and some simple guidelines for management,
based on age, are suggested. Many women have been denied or have
discontinued HRT because of the fear of risks, which may not
have been put in perspective or fully understood. The care of
postmenopausal women is not static, and sufficient has now been
learned to enable each menopausal woman, with the help of her
medical adviser, to come to a balanced and reasonable decision.
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