More menopausal women may be offered HRT under new guidelines


More women could be offered hormone replacement therapy (HRT) under new guidelines from a health watchdog.

The National Institute for Health and Care Excellence (Nice) said women should be offered HRT for hot flushes and night sweats after discussion of the risks and benefits.

Experts behind the work said HRT has become a subject that people are afraid of, with some GPs unwilling to discuss it and patients too worried to ask about it.

Research has shown that HRT increases the risk of breast and ovarian cancer, while links have also been made with stroke and heart attack.

According to a Cancer Research UK study in 2002, for every 1,000 women in the UK using any type of HRT for five years from age 50, there is one extra case of ovarian cancer. 

For every 1,000 women using oestrogen-only HRT over the same period, there is thought to be 1.5 extra cases of breast cancer, and six extra cases of breast cancer per 1,000 women taking the combination oestrogen-progestogen HRT.

Professor Mary Ann Lumsden, chair of the Nice expert group, who is also honorary consultant gynaecologist at Glasgow Royal Infirmary, said there was a need to "look again" at HRT.

She said the guideline showed that "for most women", HRT is a very effective treatment for menopausal symptoms.

She stressed that "some women are very severely affected by the menopause".

An estimated 1.5 million women - around 80% of those going through menopause - experience some symptoms, which typically continue for around four years after the last period.

For around 10% of women, symptoms can last for up to 12 years. The average age for menopause in the UK is 51.

Prof Lumsden said symptoms that are "really bothersome" - which can include low mood, hot flushes, loss of sexual desire and vaginal dryness - occur in about 20 to 25% of menopausal women.

She said countries such as the US had as many as 50% of women aged 50 to 60 going through the menopause taking HRT before the 2002 Million Women Study was published.

"However, now in most areas of the UK it would be no more than about 10%, maximum 15%," she said.

HRT treats symptoms of the menopause and the natural loss of oestrogen by boosting the body with female sex hormones.

There are three types of HRT - oestrogen-only; cyclical HRT, where oestrogen is taken continuously but progestogen, another female sex hormone, is given in monthly or three-monthly doses; and continuous combined HRT of oestrogen and progestogen.

Side-effects may include possible nausea and irregular bleeding, which Prof Lumsden said get better with time.

She said the guideline was not intended to increase the number of women on HRT.

"What we would like is that people who need it and would benefit it, have the option of considering it," she said.

"There might be a bit of a rise, there might not.

"At the moment, everyone has lost confidence in it but we would like more confidence in explaining the treatment options so individual women can be part of the decision-making.

"Since the 2002 study, GPs have lost confidence because we are taught to do no harm and you can't do harm if you don't prescribe it."

Dr Claire Knight, Cancer Research UK's health information manager, said HRT increases the risk of breast, ovarian and in some cases womb cancer, "but HRT can also offer effective relief from menopausal symptoms".

She said women needed "clear, evidence-based information around the risks and benefits to help them make an informed decision".

Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists, described the guideline as "a milestone".

He added: "For some women, menopausal symptoms can be extremely debilitating and dramatically impact upon their quality of life."

Dr Heather Currie, chairwoman of the British Menopause Society (BMS), said many women were "confused about benefits and risks of treatment options".