HRT: A difficult dilemma for GPs and for patients

The announcement that hormone replacement therapy (HRT) may be doing more harm than good poses a difficult dilemma for doctors and patients. For years, HRT has been promoted as a good way of preventing illness and delaying the onset of age-related deterioration of both mind and body.

The announcement that hormone replacement therapy (HRT) may be doing more harm than good poses a difficult dilemma for doctors and patients. For years, HRT has been promoted as a good way of preventing illness and delaying the onset of age-related deterioration of both mind and body.

HRT was supposed to prevent heart attacks and strokes, keep the bones from crumbling and ward off the symptoms of the menopause. While there has always been a suspicion that it increased the risk of breast cancer, this effect was thought to be small and relatively unimportant.

This study will make everyone think long and hard about the wisdom of continuing to prescribe long-term HRT.

For some women, particularly those who may be at higher risk of breast cancer because of their own family history of the disease, the pendulum will probably swing against taking HRT.

Women who were taking HRT as a way of trying to prevent heart attacks will have to consider that walking to work and going to the gym is probably a cheaper, safer and more effective way of staying healthy.

Even women who take HRT to try to prevent osteoporosis will have to weigh up the risks and the benefits.

Inevitably, there will be a debate about whether the results of this trial are correct. That it is the first large, well-designed, randomised, controlled trial in healthy women will mean its results cannot be ignored.

What should a woman who is taking HRT do? There is certainly no reason suddenly to stop the treatment. If the main reason for taking it is to prevent heart attacks and strokes, it may be difficult to find a doctor who will continue to prescribe it for this reason. But for some women, whose lives have been transformed by HRT, the case for continuing with the treatment may still be strong.

Like all medical treatments, HRT has always been known to have risks and benefits. The latest research allows us to calculate these more accurately.