HRT in the news

The Guardian reports on HRT and this time it's the risks rather than the benefits that get the into the press. A timely review which appeared before the Guardian article (BMJ, Roberts, H;334 p736 to 741, Managing the Menopause) provides a good grounding on which we can develop our clinical practice.

Firstly I was reassured by the advice on use of topical oestrogens. This form of HRT is useful in reducing dyspareunia and recurrent uti and is not associated with significant systemic absorption so can be used safely as a long term treatment. Women with a uterus do not need progesterone treatment in addition to the oestrogen.

Long term HRT has no role in the prevention of chronic disease. There is a significant increase in the risk of stroke, dvt, gall bladder disease with both oestrogen and combined oestrogen-progestogen treatments. Breast cancer and dementia are also increased in women over 65. Some evidence of protection against fractures and colorectal Ca in combined therapy is noted.

The consensus advice seems to be that we should use the lowest dose of hormone for the shortest duration to give symptom relief.