The study that leaves a million women with an unenviable dilemma

As research shows hormone therapy can lead to cancer, patients face limited options to cope with the onset of the menopause

Barbara Sims felt "like a new woman" after she began hormone replacement therapy for severe menopausal symptoms.

Barbara Sims felt "like a new woman" after she began hormone replacement therapy for severe menopausal symptoms. The daily tablets cured her of the debilitating hot flushes, night sweats and heavy periods which had plagued her for two years. But after six years on a combined form of HRT, she was told she had breast cancer.

In the past three years, she has had both breasts removed, undergone painful reconstructive surgery and is still taking tamoxifen tablets daily to help prevent the cancer recurring.

Mrs Sims's case highlights the dilemma facing more than a million women who are on HRT today.

She says: "My menopausal symptoms were so bad and so terrible that even now, knowing about this study, I would still have taken the HRT and run the risk of breast cancer.

"I have two daughters in their thirties and they may have to decide whether or not to take HRT. I think only a woman can decide that for herself. It's a very difficult dilemma. You just have to weigh up the risks against the benefits."

About 1.5 million women in the UK are on some form of HRT, with 750,000 of them on the combined oestrogen-progestogen form which carries the highest risk of breast cancer. This form is particularly useful for women who have not undergone a hysterectomy because the oestrogen-only alternatives carry an increased risk of endometrial cancer in the lining of the womb.

As women enter the menopause, their bodies stop producing hormones, particularly oestrogen, causing a range of symptoms such as those experienced by Mrs Sims, 56, a retired bank manager from Basildon, Essex.

She said: "I started the menopause early in my forties and it was awful. It felt like my body was breaking down. I had heavy, irregular bleeding.

"I would be drenched in sweat at night and have terrible hot flushes during the day. It was affecting my whole life. I went to the doctor and when he put me on HRT, I was like a new woman, it was fantastic."

HRT replaces naturally occurring hormones with synthetic substitutes. Some women use it for a couple of years, while others take it for up to a decade as it can help to prevent the bone disease osteoporosis.

Oestrogen-only hormone replacement therapy was developed in America in the 1920s, and began to be widely prescribed there in the 1960s. Because of this, oestrogen-only HRT is more common in the United States.

By the 1970s, HRT was becoming increasingly popular in Europe. But as evidence emerged that oestrogen could increase the risk of cancer of the uterus, doctors developed a new type of product which also had progestogen, another synthetic hormone which helped protect against cancer.

In the past 20 years, HRT has become a multimillion- pound business. Half of British women use some form of it to help them through the menopause. Prescriptions have tripled in the past decade, as patches, implants, injections and gels have been developed.

The pharmaceutical giant Wyeth is a market leader, with more than 300,000 women in Britain using its three different HRT preparations. The company issued a statement yesterday urging women to see their GP before discontinuing therapy. A spokesman said: "HRT remains a very important treatment for alleviating the distressing symptoms of the menopause that many women experience."

But some medical experts say that the growing volume of evidence about the risks of HRT means that doctors should consider more natural alternatives.

Dr Shirley Bond, a GP and medical adviser to the Natural Menopause Advice Service, said: "It is perhaps time for a cultural change in the way doctors treat the menopause.

"They tend to tell women that they have a choice between HRT and having to grin and bear it. But there are plenty of other approaches. There are food and vitamin supplements, and natural oestrogens and progesterones that can help as well."

Mrs Sims is now clear of cancer after spending the past three years in a constant round of surgery and recovery.

Ironically, the tamoxifen she takes to prevent cancer from recurring has the side-effect of bringing on a chemically induced menopause.

"It isn't nice, but after having cancer and a double mastectomy I am just getting through it," she said. "I will never know if the HRT caused my cancer, but I just have to get on and live now."

HRT: The facts

* The Million Women study has found that the combined oestrogen-progestogen therapy is twice as likely to lead to breast cancer as those who take no type of HRT.

* Women on oestrogen-only HRT are 30 per cent more likely than non-users to develop breast cancer; a rarer type of treatment called tibolone carries a 45 per cent increased risk.

* But these are relative risks. In absolute terms, there will be only six extra cases of breast cancer for every 1,000 women using any form of HRT for five years.

* There are 40,000 new cases of breast cancer a year in the UK, and 13,000 deaths.

* The risks are also only for people currently using HRT. As soon as treatment is stopped, the risk declines and after five years is back to the same level as a non-user.

* Using HRT for one year carries no increased odds of breast cancer.

* Other factors are equally important in the development of breast cancer; one unit of alcohol a day carries a 6 per cent increased risk, and women who don't have children are up to 100 per cent more likely to get the disease.

* HRT can make breast cancer harder to detect, because it makes the tissue more dense and tumours more difficult to pick up.

* Other studies have recently found that combined HRT can increase the risk of heart attacks by 29 per cent, strokes by 41 per cent and blood clots by 100 per cent.

* But it can also help prevent bone thinning, hip fractures and osteoporosis.

* A medical trial in the US is testing a native American herbal remedy called black cohosh for the relief of menopausal symptoms.

* Food supplements, vitamins and dietary changes can help alleviate the menopause.

* For the Government's updated advice on HRT, see your GP or go to the Medicines and Healthcare Products Regulatory Agency on www.mhra.gov.uk

For natural alternatives, go to the Natural Menopause Advice Service on www.nmas.org.uk or ring 0800 169 2163.