Healthy Skepticism Library item: 1522
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Meikle J.
Ban for HRT in cancer warning: 'Wonder' drug no longer first choice for osteoporosis
The Guardian 2003 Dec 4
http://www.guardian.co.uk/uk/2003/dec/04/health.healthandwellbeing
Full text:
Hormone replacement therapy, the once wonder treatment for older women, was yesterday banned as the medication of first choice for preventing osteoporosis, the debilitating bone condition that affects an estimated 3 million people in Britain.
Safety watchdogs moved to restrict the prescription of HRT because of growing fears that it increases the risk of cancer. The ruling is likely to see a sharp reduction in its use.
Government and European drug safety advisers stipulated that the “minimum effective dose” of HRT should be used for the “shortest duration” to treat menopausal symptoms such as hot flushes, night sweats and vaginal dryness. Healthy women who showed no such symptoms should refrain from taking HRT.
The warnings represent the strongest attempt yet to wean an estimated 1.7 million British women off HRT. They were advised by the government’s Medicines and Healthcare Products Regulatory Agency (MHRA) to discuss whether they should continue HRT at their next routine consultation with their doctors.
Similar advice was given in August when a study of more than 1 million women suggested women were at increased risk of contracting breast cancer within one to two years of starting HRT and that long-term use of combined oestrogen-progestogen therapies could eventually double the risk.
Until recently many women have been on HRT for years after menopause, sometimes for a decade or more. Many swore it enhanced the quality of life in a way nothing else could. About 6m prescriptions a year were made in England alone, although there is anecdotal evidence the August warning led to some women stopping its use. Wyeth, one of the big HRT suppliers, says average use is two to three years.
A Europe-wide review has led to stern guidance to health professionals who prescribe HRT. The European committee for proprietary medicinal products concluded “there is a public health concern with regards to the safe and effective use of HRT”.
Gordon Duff, the chairman of the British committee on the safety of medicines, part of the MHRA, said his members agreed that “HRT remains an effective treatment for the short-term relief of menopausal symptoms but that it should no longer be regarded as the therapy of choice for preventing osteoporosis in women over the age of 50”.
No urgent change of treatment was needed but women using it as a long-term measure should have their treatment reviewed at their next routine appointment.
In the past 18 months a string of studies has undermined the reputation of HRT. These have indicated increased risk of blood clotting, stroke and heart attack, at least for combined therapies. Oestrogen-only therapies increase the risk of cancer of the womb lining.
One in three women over 50 are thought to have osteoporosis, literally “porous bones”, a condition that sometimes accompanies menopause, though it is not a symptom of it. HRT does seem to prevent loss of bone mass and help prevent bone fractures but this benefit disappears within a few years of treatment ending.
That benefit is not now considered worth the risk if simply taken to combat osteoporosis rather than to treat menopausal symptoms.
Other drugs are available as prevention for osteoporosis, and calcium and vitamin D are valuable in reducing risk of hip fracture among older women.
Drug advisers say HRT could be used for osteoporosis prevention only when other drugs are ineffective or unsuitable. Even then, treatment decisions should be made “with care”.
Maureen Baker, honorary secretary of the Royal College of GPs, said: “We have no evidence of any panic, but people have been taking the opportunity when coming in for medication review to have discussions with their doctor and then making an informed decision about what is best.”
About half the HRT products used in Britain are licensed for osteoporosis prevention but Wyeth insisted that the safety advice reflected current practice where women are “predominantly prescribed” HRT for the short-term relief of menopausal symptoms. Most were in their late 40s and early 50s.
Sian Walker, the company’s head of medical affairs in the UK and Ireland, said: “Around 80% of women of menopausal age experience symptoms, such as hot flushes, night sweats and vaginal dryness. These can have a major impact on a woman’s quality of life.”
The crisis of confidence in HRT has led to more women considering other treatments, including a drug called clonidine to treat hot flushes, and oestrogen creams for dryness.
