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The a to z of hrt: independent studies THE A TO Z OF HRT: INDEPENDENT STUDIES
Women's acceptance of oestrogen was helped along by the statements of medical authorities such as Dr Robert Greenblatt, a leading endocrinologist who was president of the American Geriatrics Society. In 1974 Dr Greenblatt claimed that about three-quarters of menopausal women were acutely oestrogen-deficient, and he advocated oestrogen therapy for them all, even in the absence of symptoms. A year later, with prescriptions for oestrogen exceeding 26 million in the US alone (it was the fifth most frequently prescribed drug), and worldwide sales of Premarin surpassing $USioo million in value, controversy erupted.
Two independent studies by reputable US research teams, both published in the New England Journal of Medicine in 1975, reported a link between postmenopausal oestrogen therapy and cancer of the endometrium (the lining of the uterus), the risk increasing with the duration of therapy and its dose. The researchers found that women who had a uterus and used oestrogen preparations without any other sex hormones, such as progestogens (synthetic forms of progesterone), for longer than six months had an increased risk of endometrial cancer -five to ten times greater than was normal for their age.
There followed a period of widespread concern and scientific reappraisal, during which progestogens were teamed with oestrogen, the aim being to protect the endometrium of all women with an intact uterus from the increased risk of endometrial cancer. Subsequent studies have confirmed that progestogen achieves this protection.
Much has been learned from this saga, particularly the need for constant review of present knowledge, and a commitment to ongoing research of the menopause and ageing. What we can say with confidence is that in recent years there has been a resurgence of interest in HRT, together with an acceleration of research and clinical trials using therapies of different dosages in different patient groups, and the development of new ways to administer it. One of the biggest challenges now facing the medical research community is to identify women who need HRT and those who don't. Women themselves should at the same time be analysing their experience of menopause in the light of their own medical history, weighing up the evidence, and making their own judgement.
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