A row has broken out over the safety of hormone replacement therapy which is used by hundreds of thousands of women to combat the symptoms of the menopause.
Claims that HRT raises the risk of heart disease and three types of cancer were challenged yesterday by scientists who found that women had taken the therapy for up to 25 years without any significant impact on their health.
American researchers, who had followed women taking HRT for a decade, said there seemed to be no link with any life-threatening conditions and the benefits of the treatment strongly outweighed the risks, but the science remains hotly contested.
Over the past 15 years the number of British women taking HRT to stave off hot flushes, mood shifts and other effects of the menopause has halved after a wave of papers associated the therapy with a greater risk of breast cancer and other conditions.
The current advice from the NHS is that HRT is safe on balance so long as it is used for no longer than five years, but the government is expected to publish comprehensive guidelines for doctors treating the menopause next month.
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The new research, carried out by academics at New York University and presented yesterday at the annual conference of the American Society for Reproductive Medicine, is the latest in a series of studies to suggest that the treatment may be safe after all.
The scientists found that HRT, which ramps up women’s levels of oestrogen and progesterone, has no significant effect on their odds of developing diabetes, hypertension, osteoporosis or breast, womb or ovarian cancer.
Lila Nachtigall, one of the lead authors, said the 80 women on HRT had not even put on any extra body fat compared to the 100 middle-aged women in the study who were not taking the therapy. “The take-home message is mainly that these women who were on long-term oestrogen, many on over 20 years of oestrogen, remained quite healthy with very normal body composition,” she said.
However, some experts have warned that the number of women involved in the study was so small that it is impossible to draw any robust conclusions. The work was also funded by the pharmaceuticals giant Pfizer, which produces several HRT drugs, although there is no suggestion that the scientists were influenced by the company.
Simon Newman, director for research at the charity Target Ovarian Cancer, said the findings were based on an “incredibly small” number of women.
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“If you think that for ovarian cancer the lifetime risk is 2 per cent, you’ve got virtually no cases in that group,” he said. “Even with breast cancer, where the risk is 13 per cent, you need thousands of participants to get strong results. The difficulty with this study is it’s a conference presentation, not a peer-reviewed article, so it’s hard to drill into their methods and statistics.”
A review of studies involving more than 21,000 women from around the world and published in the Lancet earlier this year that found HRT raised their risk of developing ovarian cancer by 40 per cent, although even this analysis has proved controversial.
Cancer Research UK, which ran one of the original studies, still maintains on its website that the link between HRT and breast, womb and ovarian cancer is “strong”.
However Michael Savvas, a menopause specialist and consultant gynaecologist at King Edward VII’s Hospital in London, said the papers connecting HRT with cancer and heart problems had been deeply flawed because it largely relied on older women.
“My advice to women in their 50s is take HRT if you have any symptoms, safe in the knowledge that you’re not adding any extra risk, and be reassured that it’s the most effective treatment for alleviating the various symptoms of the menopause,” he said.