The effects of long term HRT

Hormonal replacement therapy has been extensively used over many years to help control the symptoms of the menopause. It has also been used for the management and prevention of chronic diseases such as osteoporosis and cardiovascular (heart and circulation) disease.

Each year many studies on the clinical use of HRT are published, and it is important periodically to review these data as a whole, and see what the overall picture shows.

One of the key organisations involved in this review process is The Cochrane Centre. It is an NHS based organisation which assesses evidence for and against the effectiveness of treatments in specific circumstances. It does this by co-opting an independent group of experts who are set the task of objectively reviewing all the published data on the subject.

Recently the Cochrane Centre has assessed the effect of long term hormone therapy on mortality, cardiovascular problems, cancer, gall bladder disease, mental alertness, fractures and quality of life.

They reviewed 19 studies involving nearly 42,000 women who had been taking either combined (oestrogen and progesterone) or oestrogen-only treatment continuously over many years. The results make disturbing reading. They found that long term combined therapy significantly increased the risk of thrombosis or embolism after one year’s use, and of stroke after three years use. The risk of breast cancer and gall bladder disease and (in women over 65 years) dementia was also increased. The results for oestrogen-only therapy were much the same except there was no significant increase in the risk of breast cancer.

On the positive side there was a significant decrease in the number of fractures and (for combined therapy) bowel cancer. The authors concluded that hormone therapy should not be used in the long term for the routine management of chronic disease such as osteoporosis or cardiovascular disease. They called for more evidence on the safety of HRT for the control of menopausal symptoms but reassuringly stated that short term use appears to be relatively safe for healthy younger women.

Reference:

Farquhar C, Marjoribanks J, Lethaby A, Suckling JA, Lamberts Q. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004143. DOI: 10.1002/14651858.CD004143.pub2.

Information written by talkhealth medical panel

Last Reviewed: 1 November 2010
Next Review Date: 1 November 2012