Study confirms no HRT benefit for older women

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New evidence published in August by the BMJ (formerly British Medical Journal) confirms that hormone replacement therapy (HRT) should not be prescribed to older women who are many years past menopause to help prevent chronic conditions such as heart disease.

In 2002, the Women's Health Initiative (WHI) trial found that postmenopausal women taking HRT had more heart attacks and strokes than non‑HRT users. The trial was halted early and millions of women around the world stopped taking HRT.

In 1999, another trial (WISDOM) began to assess the long‑term risks and benefits of HRT after the menopause. This trial was also stopped after the first WHI results appeared, but recently published its findings as relates to HRT when it is initiated in older postmenopausal women. The WISDOM team identified 5,692 healthy women registered at general practices in the UK, Australia and New Zealand with an average age of 63 years and 15 years after the menopause.

The women who had not had a hysterectomy were split at random into two groups. One was given a daily dose of combined hormone therapy (oestrogen and progestogen) and the other group was given a placebo pill. Women who had had a hysterectomy were split between combined hormone treatment, oestrogen only and a placebo. All women were monitored for an average of 12 months and main outcomes such as cardiovascular disease, osteoporotic fractures, breast cancer and deaths, were recorded.

Although rates for cerebrovascular disease, breast or other cancers, fractures and overall deaths were not significantly different in these two groups, there was a significant increase in the number of major cardiovascular events (angina, heart attack or sudden coronary death) and blood clots (venous thromboembolisms) in the combined hormone therapy group compared to the placebo group.

This study confirms an early increase in thromboembolic and cardiovascular risk in older women starting hormone replacement therapy many years after the menopause, say the authors. It shows that there is no overall disease prevention benefit, and some potential risk, for women who start hormone replacement therapy many years after menopause.

The results are also consistent with the early findings of the WHI and other trials, and support the conclusion that combined oestrogen and progestogen therapy should not be initiated to prevent cardiovascular disease in older postmenopausal women.