Fed: HRT all in the timing, studies suggest

AAP General News (Australia)
02-16-2006
Fed: HRT all in the timing, studies suggest

By Janelle Miles, National Medical Correspondent

BRISBANE, Feb 16 AAP - Hormone Replacement Therapy (HRT) seems to be all in the timing.

Recent studies suggest women may derive some brain and heart protection, as well as
relief from hot flushes and other symptoms, if they start HRT early in menopause, around
age 50.

The results should go a long way to calm the fears created by the 2002 American Womens'
Health Initiative (WHI) study of more than 10,000 women which caused panic when it linked
HRT to heart disease and dementia.

Contrary to that study, the latest research suggests those results were misleading
because the average age of the participants was 63 when they started taking HRT - well
after the onset of the menopause.

The WHI researchers published findings in the Archives of Internal Medicine this week
suggesting oestrogen therapy offered a small reduction in cardiac risk among women aged
50 to 59.

Although that finding was not statistically significant, Australian gynaecologist Rod
Baber, who helped draw up national HRT guidelines in 2004, said the message was clear
- women taking HRT in their fifties to relieve menopausal symptoms were not increasing
their risk of cardiac problems.

"You shouldn't use hormone therapy to treat heart disease, but if you have hot flushes
and are going through the menopause and need to take hormones, you can do it pretty confidently
without fearing that it's going to give you heart disease," Associate Professor Baber
said.

"This confirms what many doctors thought all along, which is that HRT in younger women
doesn't increase the risk of heart disease."

The latest findings support recent South Australian research, which suggested the timing
of HRT was important when considering brain risk.

That study of 428 randomly-selected women aged over 60 found those who started HRT
early in menopause, around the age of 50, had less memory loss later in life than non-users.

But lead researcher Alastair MacLennan said the study found starting HRT many years
after menopause may be mildly detrimental to brain function, in line with the 2002 WHI
results.

"There appears to be a critical window of therapeutic opportunity to derive brain and
heart protection from HRT if it is started around menopause," Prof MacLennan said.

Prof Baber said the advice to doctors and women in light of the recent research should
be to take HRT early in menopause at the lowest possible dose to alleviate symptoms.

"When your symptoms have gone then you should stop," he said in an interview.

"For 80 to 90 per cent of women that will mean less than five years of HRT use.

"If you don't have menopausal symptoms then you don't need HRT."

Prof Baber said previous research had shown that using oestrogen and progestin therapy
beyond five years caused a small increase in breast cancer.

"Although hormones are powerful drugs, and they need to be carefully considered before
you take them, the evidence that we've seen in the last month makes us feel much more
confident that they can be taken in the short term very safely," he said.

AAP jhm/br

KEYWORD: HRT

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