Is it really necessary to take HRT for years?

Is it really necessary to take HRT for years?

 

Is it really necessary to take HRT for years? Sir Edward Dodds wrote in 1945 that ‘disturbing symptoms of menopause’ could be successfully treated by administering oestrogen in decreasing amounts over a period of a one year. The symptoms were suppressed during the course of the therapy. They did not recur when it was fully discontinued. One year therapy was ample.

The SEER Program database from 1975 through 2014 looked at why endometrial cancer incidence were increasing. Risk factors associated with endometrial cancer, including age, obesity, diabetes, diet and exercise. Importantly they include reproductive factors and medications (hormone therapy [HT] including  [compounded] oestrogens and progestogens, tamoxifen, and hormonal contraceptives.

The PubMed searches looked at trends in risk factors compared with endometrial cancer trends from SEER.

Although endometrial cancer rates were constant from 1992 to 2002 (women 50–74 years of age), they increased 2.5% annually with a 10% increase from 2006 to 2012.

The use of oestrogen–progesterone combination products decreased after the publication of the Women’s Health Initiative (WHI) data. This suggested that postmenopausal participants who were taking oestrogen and progestin (a synthetic form of progesterone) had slightly increased risks of breast cancer, heart attack and stroke¹. The findings — widely misinterpreted and overgeneralized — sparked fear among women and clinicians.

The SEER program showed that compounded bioidentical HT (CBHT) use increased coincident with the endometrial cancer increase.

The US FDA is removing serious health warnings from hormone replacement therapies. Some now worry that removing the labels entirely, or making overly broad claims about hormones, health and longevity, will restrict informed consent.

Endometrial cancer rates are increasing. The use of CBHT and prevalence of obesity and diabetes are factors. Any use of hormones requires further evaluation so women can make an informed decision about their health and treatment.