HRT has been the subject of intense debate since the publication of two major trials in Womens’ Health Initiative (WHI) and the Million Women Study (MWS) in the early 2000s, reporting an increased link with breast cancer that was greater in women taking combined HRT compared with estrogen only, and that the risk was time related. Furthermore, the WHI study demonstrated an increase in breast cancer, heart disease, stroke and VTE events whilst there was a reduction in fracture rate, bowel cancer and diabetes.
Reanalysis of the WHI study indicated that giving HRT to women within 10 years of the menopause conferred a cardioprotective effect with a reduction of cardiovascular events but later administration of HRT >20 years post menopause produced an increased risk of cardiovascular harm. This introduced the concept of the ‘window of opportunity’ with HRT use in the younger postmenopausal woman and that use of HRT >60 years of age was harmful.
There is still considerable confusion amongst GPs and hospital specialists as to what advice menopausal women should be given so that they can make an informed decision as to whether or not the risk/benefit ratio is acceptable to them.
Recent case law has heralded the advent of Informed consent in the UK putting considerable onus on healthcare professionals to counsel their patients about material risks associated with the prescription of HRT. Failure to do so could leave the prescriber open to litigation for medical negligence.
HRT Breast cancer Cardiovascular risk Informed consent Montgomery
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