HORMONE replacement therapy significantly increases the life expectancy of older women, but only if they begin taking the drugs soon after the onset of the menopause, a major review of the evidence has found.

A new analysis of 30 trials involving a total of 26,708 women has revealed that the benefits of the treatment substantially outweigh the risks, so long as it is started before a woman reaches the age of 60.

In women who started HRT at 56, the risk of death from all causes was cut by 39 per cent, the research found. However, there was no change in the mortality rate of women who started HRT at 66. The cut-off appears to lie at about the age of 60.

The findings, from a team led by Shelley Salpeter, Professor of Medicine at Stanford University in California, add to growing evidence that HRT can protect the health of women after the menopause. The study is the latest to indicate that HRT should not be written off, despite the potential dangers to health identified in the abandoned Women’s Health Initiative (WHI) trial.

Hundreds of thousands of women have stopped taking the hormonal drugs since the WHI reported in 2002 that one form of the treatment could raise the risk of heart disease, stroke and breast cancer. The British Million Women study also identified similar dangers.

Many experts, however, believe that these results have been widely misinterpreted and that HRT should remain a frontline drug for many older women. Most of the patients enrolled in the WHI were aged over 60, and thus do not belong to the group who have most to gain from the treatment. The Stanford research, along with another study from Yale University, suggest its conclusions may be flawed.

The Stanford review, which is published in the Journal of General Internal Medicine and was discussed yesterday at the conference, compared death rates among women of different ages taking part in HRT trials, including the WHI.

“When the results of the two age groups were compared, HRT was associated with significantly lower mortality in the younger group,” it concluded. “Treatment decisions concerning hormone replacement must be made on an individual basis, taking into account the age of the woman, the degree of bothersome postmenopausal symptoms, and any associated disease risk factors. The results of this analysis indicate that the benefits of HRT may outweigh the risks if treatment is given to younger women.”

Karen Winterhalter, of the menopause charity Women’s Health Concern, said: “This study is really good news. Every woman who has stopped taking HRT because she was scared of the risks should be banging on her GP’s door asking to go back on treatment.”

Nick Panay, consultant gynaecologist at Queen Charlotte’s Hospital, London, added: “It’s encouraging that among older women using HRT there is no excess risk of dying. But it shows a possible protective effect for younger women using HRT during a window of opportunity that we think exists when they go through the menopause.”

The study did not look specifically at the reasons why women who start HRT early live longer, though several plausible factors have been identified by other research. Virtually every HRT trial has found that the drugs reduce the risk of osteoporosis and colon cancer.

While these studies found no cardiovascular benefits, others have suggested that HRT does improve heart health, improving the balance of “good” and “bad” cholesterol and preventing hardening of the arteries (atherosclerosis). Oestrogen is thought to guard against this in premenopausal women, and as the risk rises sharply after the menopause this is where starting the drugs quickly may carry the greatest benefit.

“It is possible that if HRT is started in women in the early postmenopausal period, well before the development of atherosclerosis, primary prevention could be achieved,” the study found. “In fact, there is some evidence from clinical trials and animal studies that HRT can halt the progression of atherosclerosis if treatment is started early in the course of the disease.”

The Stanford study did not assess women’s life expectancy, but it was able to show that their chances of dying during one of the trials — a good predictor of life expectancy — was significantly lower than that of women taking no hormonal drugs.

www.timesonline.co.uk/health
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