HRT may be beneficial after all, scientists say

NEW forms of HRT could provide safe treatments for postmenopausal women in the future, a team of researchers said yesterday.

The US scientists said it would be wrong to write off hormone replacement therapy because of studies that exposed health risks such as heart attacks, strokes and breast cancer.

Not all HRT hormones are the same, they pointed out.

Nor do they behave the same way in different parts of the body.

After reviewing the scientific literature on oestrogen and progestogen, the scientists concluded that HRT should be given a chance.

Progestogen is a synthetic form of the natural hormone progesterone.

Professor Phyllis Wise, a member of the team from the University of California at Davis, said: "As our understanding of the biology of these hormones grows, we realise how important certain factors are such as formulation, dosage, whether they're given by a pill or patch, and characteristics of the women treated.

"More targeted therapies may yield important health benefits."

Serious concerns about HRT have been raised.

In 2002, a large US study, the Women's Health Initiative (WHI), was stopped three years early because it revealed unacceptably high risks of breast cancer, heart attack and stroke.

The study was the largest ever undertaken of the combined hormones oestrogen and progestogen.

Last year, a Cancer Research UK study of more than a million women found those on a combined HRT pill were twice as likely to develop breast cancer as those not on HRT.

Last month, a remaining arm of the WHI found oestrogen-only therapy reserved for women who have had their wombs removed was linked to an increased risk of strokes.

Prof Judith Turgeon, also from the University of California at Davis, who led the review published yesterday in the journal Science, said: "It was right to close the WHI trial, but we should not generalise the results of this trial and overlook the real potential that other forms of hormone therapy may offer to postmenopausal women."

As well as revealing risks, the WHI found that HRT could protect women against fractures and colon cancer, the researchers pointed out.

There were many types of oestrogens and progestogens, and each may have different effects, they said.

Furthermore, tissues throughout the body responded differently to the same oestrogen and progestogen.

Tamoxifen, an oestrogen- like drug used to treat breast cancer, blocked the effects of the hormone in the breast, but had the opposite effect in bones and the womb.

Prof Wise said: "Oestrogens are important to maintain normal brain function and may protect against neurodegeneration.

"There are so many potential benefits of oestrogens and progestogens after menopause that therapy with these hormones should not be disregarded based on a single study.

"Our goal is to find the right formulation and circumstances that will enable us to retain health benefits, while eliminating risks," she added.

Critics have accused the medical establishment of delivering mixed messages about HRT which have confused patients.

Earlier this year a senior scientist who took part in the WHI said almost a third of women who have abandoned HRT on health grounds may have made the wrong choice.

Prof Susan Johnson told the annual meeting of the American Association for the Advancement of Science in Seattle that HRT still offered a "huge benefit" to women taking it for short periods to control debilitating hot flushes.