Menopausal women missing out because of misinformation

New Zealand women are missing out on a valuable treatment for menopause symptoms because of fears raised by outdated research.

The popularity of hormone replacement therapy (HRT) plunged a few years ago as doctors encouraged patients to stop using the hormones after studies found they increased the risk of breast cancer, heart attack and stroke.

But newer research shows a form of HRT, using just the hormone oestrogen, has lower risks than previously believed, and in some cases protects women against breast cancer.

However, that message does not appear to be getting through to New Zealand women - partly because medical guidelines in New Zealand are less enthusiastic about oestrogen therapy than they are in some other countries.

Reproductive endocrinologist Anna Fenton is alarmed at the number of women arriving at her Christchurch clinic because their GPs are reluctant to go against medical guidelines and prescribe them HRT.

The new information, released in April 2004, clarifies the risks and benefits for women of various ages starting on HRT. The findings are part of the same major, United States-based Women's Health Initiative study into HRT which earlier found that women participants faced "an unacceptably high risk" of breast cancer.

The new data comes from the oestrogen-alone part of the study. Its results revealed that women using oestrogen alone have a significantly lower risk of breast cancer and heart disease than women taking no hormone therapy.

"The main concern with oestrogen now is that perhaps the risk of stroke and leg clots is increased slightly," said Dr Fenton.

"But this is primarily in women over 65 years and in the case of DVT [clots], mainly in those who are overweight."

The new findings appear to place the blame for increased risk of breast cancer on the hormone progesterone, which was added to HRT about 20 years ago.

But although the risks initially uncovered by the study were well-publicised, the latest good news has had less impact and many women still fear HRT.

The new oestrogen-only results were presented at the International Menopause Congress last October, but have not yet made it into the public arena in New Zealand.

"At the moment," said Dr Fenton, "the current New Zealand guidelines [for general practitioners to follow] are certainly not regarded as appropriate by world experts.

"Women are hamstrung," she said. "They are caught between the politics of health activists and [specialist] doctors."