GPs should ‘warn’ patients that HRT increases the risk of cancer, health chiefs say

Menopausal women should be warned that hormone replacement therapy (HRT) can increase their risk of breast, ovarian and uterine cancer, according to new NHS guidance.

The drugs, which relieve hot sweats and night sweats, offer ‘huge benefits’, health chiefs say, but the downsides need to be identified so patients can make an informed decision.

The new guidelines include special recommendations for counseling women over the age of 45, when the health risks from hormones are thought to increase further.

Overall, the guideline states that HRT is ‘the preferred, recommended approach’ for treating some symptoms of menopause.

However, it is ‘unlikely to change life expectancy’ and ‘personal conversations’ with a GP should determine whether or not a patient is taking the drug.

It comes after Britain’s health watchdog, the Care Quality Commission (CQC), launched an investigation into a celebrity-backed private menopause clinic following allegations it was prescribing very high doses of HRT to patients.

More than a dozen patients at Newson Health – led by TV menopause guru Dr Louise Newson – told the BBC that the drugs had caused them health problems.

Some developed a thickening of their uterine lining, a possible precursor to cancer.

Hormone replacement therapy offers ‘huge benefits for women’ and should be the first line of treatment for menopausal symptoms, a health watchdog says today (file image)

The British Menopause Society (BMS) has appointed Dr. Newson was removed from its register of menopause specialists last year following the organisation’s concerns about its practices.

In a new statement, Dr Newson described the latest guidance update from the National Institute for Health and Care Excellence (NICE) as ‘disappointing’.

She added that “the word risk is used three times as often as the word benefit.”

Dr. Newson said: ‘The guidelines do not distinguish between older, synthetic HRT and the natural body-identical hormones that are now more commonly prescribed… these newer forms offer more benefits than risks.

‘The real risk lies in not taking HRT at all, with good quality evidence showing that low hormones increase the risk of heart disease, osteoporosis, type 2 diabetes and dementia.’

In a marked move away from draft guidelines published last year, NICE said cognitive behavioral therapy (CBT) should only be considered as an addition to HRT unless women are unable or unwilling to take the medication.

Last year’s draft guidelines said CBT could be used ‘alongside or as an alternative to’ HRT to help reduce symptoms of menopause. But this proposal was heavily criticized.

The change follows extensive consultation with healthcare providers, patients and research organizations, which the independent committee said was taken ‘very seriously’.

Dr. Newson said: ‘The guidelines do not distinguish between older, synthetic HRT and the natural body-identical hormones that are now more commonly prescribed… these newer forms offer more benefits than risks.’

NICE boss Professor Jonathan Benger said: ‘HRT is our recommended first-line treatment for vasomotor symptoms – hot flushes and night sweats.

‘We recommend that [it] should be offered to women, provided it meets their needs, and after informed discussion.

In addition to the revised guideline, the regulator has developed a ‘discussion tool’ for general practitioners and patients.

This includes data on how HRT may slightly increase the risk of certain health problems.

A review of the evidence found that there was no link with an increase in heart disease, stroke or dementia when HRT was started at the typical time of menopause, between 45 and 55 years.

The new NICE guidance also addressed the use of cognitive behavioral therapy, a form of psychotherapy that has also been shown to help reduce some symptoms of menopause.

Prof Benger said: ‘We have revised the guidelines to make it really clear that CBT is an adjunct, it is a complementary therapy, and it can help people manage symptoms… in addition to HRT, or some women may choose to not to do that. take HRT, otherwise they may not be able to take HRT, and so CBT can be helpful at this point.

‘But we are very keen to emphasize that HRT is our recommended first-line treatment for vasomotor symptoms and for menopausal symptoms.’

Marie Anne Ledingham, clinical advisor at NICE, said: ‘While there are some increased risks associated with taking HRT for menopausal symptoms, there are obviously a huge number of benefits for women.

‘The updated guidelines advise healthcare providers to tailor information about the benefits and risks of HRT for these individual symptoms based on the person’s age, their individual circumstances and any additional potential risk factors.’