HRT 'does not raise risk of breast cancer'

Women should not be put off hormone replacement therapy by over-hyped fears about its health risks, a panel of international experts has concluded.

For women aged 50 to 59 in the early years of the menopause, HRT is safe and effective, said the scientists. It alleviated menopausal symptoms such as hot flushes and maintained healthy bones without significant harmful side effects.

Contrary to what many people had been led to believe, HRT did not raise the risk of heart disease for these women, and its impact on breast cancer was "minimal", the experts reported.

Although certain types of HRT containing combinations of oestrogen and progesterone could slightly increase the chances of developing breast cancer, their effect was dwarfed by other risk factors.

Dr David Sturdee, one of the report's authors and president-elect of the International Menopause Society, said doctors should be prescribing HRT more freely.

The current advice to health professionals is that HRT should only be offered to women with serious menopausal symptoms for the shortest time possible. After five years doctors are not expected to continue prescribing the treatment without thoroughly discussing the potential risks with the patient.

"We feel women should have it for as long as they need it to maintain their quality of life," said Dr Sturdee, speaking at the Science Media Centre in London.

Forty experts from around the world took part in a summit in Zurich, Switzerland, to discuss the latest evidence on the health risks of HRT.

They presented their findings yesterday at the World Congress on the Menopause in Madrid.

The scientists said the health hazards of HRT had been blown out of proportion largely because of misleading results from a major American investigation, the Women's Health Initiative (WHI).

In 2002 the WHI produced data which appeared to show that women on HRT were at a heightened risk of breast cancer and heart disease.

It had a major impact, causing large numbers of post-menopausal women to avoid hormone replacement and convincing many doctors that the treatment was not safe.

Since its publication the research has been strongly criticised for presenting an unbalanced picture. In particular WHI researchers were accused of focusing on the wrong group of women. The average age of the study participants was 63, whereas most women start taking HRT a decade earlier.

In addition 36% of the women had high blood pressure, 49% were current or past smokers, and 34% were clinically obese - all factors which could contribute to health problems.

It was also claimed that the study failed to make clear the varying risks and benefits of different types of HRT.

After reviewing the evidence, the summit experts concluded that:

* Combination oestrogen and progesterone HRT did not raise the risk of heart disease in healthy women aged 50 to 59. Oestrogen-only HRT, normally reserved for women who have had their wombs removed, actually decreased heart disease risk;

* Oestrogen and progesterone HRT did slightly increase the risk of breast cancer for women in this group. However, the effect was minimal compared with other risk factors. Short-to-medium term use of oestrogen-only HRT was not associated with a raised risk of breast cancer. Healthy women entering the menopause should not worry about HRT and breast cancer;

* HRT effectively maintained bone density in women aged 50 to 59 and could help prevent the brittle bone disease osteoporosis, a recognised symptom of the menopause;

* HRT did not impair the thinking processes of women aged 50 to 59 and may even delay the age-related blunting of mental abilities.

Dr Sturdee, a consultant obstetrician and gynaecologist at Solihull Hospital, said at least a million women in the UK had stopped taking HRT because of unfounded health fears and suffered as a result.

There were also anecdotal reports of doctors imposing a blanket ban on HRT, even this was at odds with current guidelines.

"Women's confidence has been shattered," said Dr Sturdee. "They are going to take a lot of convincing that the initial reports weren't actually a reliable assessment of the data."