Help might be at hand for an estimated million women who suffer menopause silently after being scared off hormone therapy. New NHS guidelines seek to reassure women and doctors on the safety of such treatment and the need for a case-by-case review.
The number of women taking hormone replacement therapy (HRT) almost halved -- from 6 million in 2000 to 3.8 million in 2004 -- following a study associating it with increased risk of breast cancer. While not refuting the link, guidelines from the National Institute of Health and Care Excellence (Nice) note that the increased risk lasted only as long as the women were on therapy and did not have a longer-term impact. Besides, it was seen more in older women who had used the drugs over longer periods.
Breast cancer risks anyway rise for those who are overweight or drink regularly. Consequently, Nice called upon GPs to adopt a more balanced approach in weighing the risks and benefits for each individual.
Around 1.5 million women experience menopausal symptoms such as hot flushes and night sweats soaking the bed. Of them, about around 400,000 suffer them to a "troublesome" extent.
Currently, only one in 10 women going through menopause is prescribed hormone treatment, by far the most effective treatment to manage symptoms of oestrogen deficiency, Nice said. One woman in 100 experiences premature menopause before the age of 40. Those women would particularly benefit from hormonal therapy, Nice added.
If 1,000 women aged 50 were not taking HRT, around 22 would be expected to develop breast cancer over seven years, Nice found. If the same number were put on combined oestrogen and progesterone treatment, there would be around five more cases, said Dr Imogen Shaw, one of the authors of the guidelines.
Cancer scientists, however, were wary about the guidelines to rehabilitate HRT without sufficient recognition of the long-term potential harm. Prof Valerie Beral, an Oxford epidemiologist who leads the Million Women study which linked HRT to breast and ovarian cancer, spoke to the Guardian on the risks.
"About one million UK women are currently using hormones for the menopause," she told the daily. "Among them, about 10,000 extra breast cancers are estimated to occur in the next 10 years [40,000, instead of 30,000 if the women had not used the hormones]. Also about 1,000 extra ovarian cancers are estimated to occur among them in the next 10 years [6,000 in total]."
Among the two types of HRT – a common one that combines oestrogen and progesterone, and another oestrogen-only therapy – the latter does not carry the same increased risk of breast cancer and heart disease but has shown a rise in womb cancer. It is recommended only to women who have undergone hysterectomy.