This is an important study for it refutes current teaching. It has long been known that HRT may increase the incidence of breast cancer. The cause is the oestrogen content of HRT. If the oestrogen is unopposed by progestogen, it is also known to increase the incidence of endometrial cancer. Fortunately the early signs of endometrial cancer are so obvious that even when this has developed after HRT, because women have been taking the oestrogen in the HRT this hasn’t led to an appreciably increased death rate. The received opinion on the influence of HRT on the ovaries was that unlike the apparently beneficial effect of taking the Pill, HRT — which has much the same constituents — was neutral.

This apparent paradox has been attributed to the ability of the Pill to reduce the number of ovulatory cycles a woman has in her lifetime. The association between a higher number of cycles and an increased likelihood of developing ovarian cancer is well demonstrated. By the time most women take HRT, this contraceptive advantage would be lost because she would be beyond childbearing age, and the disadvantages of the oestrogen in the HRT would not be counterbalanced by the lower number of cycles when on contraception.

It is considered that the recent HRT advice about its action on the cardiovascular system was interpreted too harshly by many doctors, and in any case the earlier statistics were wrong. Research last month reversed the findings that had suggested that HRT increased some forms of cardiovascular disease. It cuts the incidence of coronaries and its effect on strokes is neutral. HRT is, was, and always has been the ideal medication for severe symptoms of the menopause. The criterion is that if these are bad enough to interfere with the woman’s domestic, social or professional life HRT is one of the treatments that is indicated.

It is ideally used as short term therapy for a year or two over the peri-menopausal years, but as in any treatment the benefits have to weighed against the known risks.

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