Should women really “have no fears” about using HRT?

The first global summit of  40 “menopause experts” convened last week to review the current evidence, risks and benefits of using hormone replacement therapy for women in early menopause. They concluded that HRT is indeed safe for healthy women entering menopause, despite what the 2002 government-sponsored WHI study showed.  They went so far to state that women should “have no fears” about its use.”  I don’t know about you, but I find that statement quite startling in light of all the research that has concluded that HRT poses a number of significant health risks. 

It’s worth reading the entire press statement published by the International Menopause Society, the summit’s sponsor, to judge for yourself the merits of their arguments.

To begin with, the panel concluded that the 2002 WHI study was “over interpreted and negatively slanted,” and that the study’s investigators failed to emphasize the data.  They added that “the results of the WHI…were prematurely released before the study was completed and before the results could be properly evaluated. As a result it is clear that the WHI showed that properly timed HRT is safe for healthy women in their early postmenopause and has major preventative effects against fractures. It reduces mortality and this may be, in large part, due to the prevention of heart disease.”

The summary statement lays out a list of perceptions vs. scientific data in four categories: cognition, breast, bone and heart disease & stroke.  Here’s a partial list of the evidence presented:

• HRT in women aged 50-59 does not increase risk of coronary heart disease in healthy women and may even decrease the risk in this age group.
• After five years’ use of combined estrogen and progestogen, there is a small increase in risk of breast cancer in North American women of about eight extra cases per 10,000 women per year.
• Overall, HRT is effective in the prevention of all osteoporosis-related fractures, even in patients at low risk of fracture. And, although no head-to-head studies have compared HRT to bisphosphonates in terms of fracture reduction, there is no evidence to suggest that bisphosphonates or any other antiresorptive therapy are superior to HRT.
• At present, there is no evidence of substantial cognitive decline across menopausal transition. However, many women experience cognitive difficulties in association with vasomotor symptoms, sleep disturbances and mood changes.

Unfortunately, this Global Summit meeting of experts was held “with the assistance of unrestricted educational grants” received from three pharmaceutical companies that manufacture and market hormones; Wyeth, Bayer-Schering and Novo Nordisk Femcare.  This diminishes, in my view, the value and integrity of the panel’s recommendations and they unfortunately missed an opportunity to move the HRT debate forward despite the research, analysis and debate that took place.

The stated aim of the summit was “to narrow the gap between the evidence and its perception by health professionals and the lay public.” If they really want to allay women’s concerns about HRT, and set the record straight with new thinking, the International Menopause Society should cut their ties with companies that have a financial stake in the debate’s outcome.

Do you agree that the integrity of the panel’s findings were compromised by its association with the three pharmaceutical companies? Did their recommendations convince you that it’s safe to take hormones?  I hope you’ll share your views here.