The debate over whether hormone replacement therapy is appropriate as a treatment for menopausal symptoms has reared up again as the prevalent view that HRT is too risky has been challenged.

A statement issued by the International Menopausal Society has called into question the findings of a high-profile study from the Women’s Health Initiative which led to a slump in the sales of HRT products. The WHI study was stopped early, in 2002, due to a 26% increase in the risk of breast cancer in women who had taken combination HRT for an average of 5.6 years, as well as evidence that overall health risks (including coronary heart disease, stroke and pulmonary embolism) outweighed any benefits of therapy.

However the IMS statement is scathing of the WHI study. The results were prematurely released before the study was completed and properly evaluated, it claims, and “the results were over-interpreted and negatively slanted”.

Further the IMS says the WHI study “failed to emphasise the data which pointed at the vast importance of age and time since menopause as major determinants of the benefit–risk equilibrium of HRT”. At present, the society continues, “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 also reduces mortality and this may be, in large part, due to prevention of heart disease”, IMS claimed.

The statement goes on to say that “actual scientific facts and data have become trivialised in the mass media, often receiving less editorial scrutiny than normal journalism”. It also notes that many HRT prescribers and users “do not attempt to broaden their
knowledge on menopause and its treatment beyond capturing headlines or short commentaries, often produced by unqualified or prejudiced sources or unprofessional people”.

However Valerie Beral, a cancer expert of Oxford University is not convinced by the IMS findings. She told the BBC that the latest study had serious flaws, and quoted only a small fraction of the evidence.

She said regulatory bodies in the UK, USA and Europe have all examined the data on HRT, and did not come to the same conclusion. For example, a review by the UK’s Medicines and Healthcare products Regulatory Agency last year concluded that current guidelines advising on strict limits on the use of HRT were appropriate.