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09-10-2012 | General practice | Article

Balance tipped in HRT’s favour?


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medwireNews: Latest research suggests that the benefits of long-term hormone replacement therapy (HRT) in terms of lowered risk of mortality and cardiovascular events outweigh potential harms.

The study, published in the BMJ, found that women who started HRT soon after menopause had a significantly reduced risk of mortality, heart failure or myocardial infarction at 10 years of follow-up, without any increase in risk of cancer, venous thromboembolism or stroke.

The study included 1006 women aged 45-58 years without a history of bone disease or cancer. Of these, 504 were randomly allocated to take combination HRT (synthetic 17-β-estradiol and norethisterone acetate), beginning recently after menopause (3-24 months after last menstrual bleed) or while having perimenopausal symptoms, such as irregular menstruations, in combination low serum follicle stimulating hormone levels.

Follow-up at 10 years showed that the primary composite endpoint of death, admission to hospital for heart failure and myocardial infarction occurred in just 16 women in the HRT group compared with 33 in the control group - representing a 52% lower relative risk.

There was no statistical difference in rates of cancer (36 vs 33 cases) or breast cancer specifically (10 vs 17 cases) in the HRT versus control groups. Nor did rates of deep vein thrombosis (two versus one cases) and stroke (11 versus 14) differ significantly between groups.

The authors, led by Dr Louise Lind Schierbeck (Hvidore Hospital, Denmark), note that the same pattern was seen after 6 years of further, non-randomised follow-up.

But Dr Claire Knight, from Cancer Research UK, cautioned that the study was relatively small and not designed to look at cancer risk specifically; she highlighted recent data showing that just over 3% of cases of breast cancer in the UK are linked to HRT.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price