Feel free to use these quotes in your stories. Any further comments will be posted here. If you would like a copy of the paper and press release or would like to speak to an expert, please don’t hesitate to contact us on (08) 8207 7415 or by email.

Professor Henry Burger is Former Director of Prince Henry’s Institute and an Honorary Professorial Fellow at Monash University. He is former president of the International Menopause Society and a consultant endocrinologist at the Jean Hailes Foundation for Women’s Health.

“This paper reports a statistically significant, small beneficial effect of one year ofhormone therapy ( HRT) on hot flushes, night sweats, insomnia, muscle and joint aches and pains, and sexuality, in 2130 women seen in general practice in the UK, Australia and New Zealand, who participated in what was planned to be a long-term study of benefit and risk, but was terminated prematurely following the announcement of the results of a similar study in the USA. The women were of average age almost 64 years, and 13 years since menopause. They were older than women usually considered for HRT, who are in their late 40′s or early 50′s and within 5 years of menopause, and are treated primarily because of moderate to severe hot flushes and night sweats, now with lower doses of oestrogen than were used in the study. Improved quality of lifemay thus bea benefit of treatment even many years after menopause, although the risks of treatment in that age group may include a transient increase in heart disease and in venous thrombosis, generally discouraging initiation of treatmentat that stage. The findings are unlikely to impact significantly on the current management of menopausal symptoms, very effectively and safely accomplished with currently used doses of HRT.”

Professor Anne Kavanagh is Director of the Key Centre for Women’s Health in Society at the University of Melbourne.

“The increased risk of serious diseases including breast cancer, coronary heart disease and blood clots with the use of combined oestrogen and progesterone therapy is now well established. While this study shows some short-term benefits of combined hormone therapy use on symptoms such as hot flushes, night sweats and joint pain it did not show overall improvements in overall quality of life or depression; in fact, the study found that quality of life was actually lower in the women taking hormone therapy in the first few months of commencing treatment. Further, a considerable number of women who stopped taking the hormone therapy did not continue participating in the study raising concerns about whether the study’s conclusions are accurate.

I recommend that women consult their doctors to talk about the risk and benefits of taking hormone therapy before commencing treatment. Doctors need to emphasise the potential risk of long-term use of hormone therapy.”

Dr Edith Weisberg is Director of Research at Family Planning Association Health and Senior Clinical Lecturer in Obstetrics & Gynaecology at the University of Sydney.

” I think the research confirms what we already know, namely the women who have menopausal symptoms such as hot flushes and disturbed sleep (usually as a result of hot flushes) find their quality of life improves on HRT which is a very effective treatment. The problem with WISDOM is that it was stopped prematurely so that over a third of women randomised did not stay in the study long enough to be evaluated, reducing the validity of the results. The improvement in sexual function related to improvement of oestrogen levels which restores the vagina to normal health is also well known.

This study confirms that for menopausal women with symptoms the benefits of up to 4-5 years of use to their quality of life outweighs the risks. Women need to be fully informed about benefits and risks and need to weigh these up individually in order to make a decision about HRT use. The NHMRC has a very good decision tool for assistance with this.”

The AusSMC has rounded up Australian experts to comment on this research. Feel free to use the comments below in your stories. If you would like to speak to an expert, or need a copy of the paper and press release, please don’t hesitate to contact us on (08) 8207 7415 or by email.

Professor Neville Hacker is Director of the Gynaecological Cancer Centre at the Royal Hospital for Women, Sydney.

“I am surprised by the magnitude in the reduction in breast cancer, but it does confirm previous studies that there is a link between use of HRT and increased incidence of breast cancer. I think the message from the study really is that risk of breast cancer from HRT is cumulative and that women should not take HRT for any longer than is necessary to control the symptoms of menopause.”

Professor Henry Burger is Former Director of Prince Henry’s Institute and an Honorary Professorial Fellow at Monash University. He is former president of the International Menopause Society.

“The authors from the NSW Cancer Council report a drop in hormone therapy use between 2001 and 2003 and an associated drop in the incidence of breast cancer over the same period. There is also a fall in breast cancer rates between 1998 and 1999 which appears to be of the same sort of magnitude and yet between 1998 and 1999 HRT prescription rates were actually increasing. The overall significance of the association is not impressive.

Rather surprisingly and puzzlingly their data shows a drop in HRT prescriptions from 2001 to 2002 – a year before the American Women’s Health Initiative report even linked HRT to breast cancer. It is not all clear why HRT prescriptions dropped between 2001 and 2002 but despite this there does not appear to be any change in breast cancer rates between during this period. There is only a very small albeit statistically significant change between 2002 and 2003 which is associated with a further fall in prescription rates.

If hormone therapy was a cause of breast cancer you would actually expect cancer rates to continue to increase even after a drop in prescription rates. For example breast cancer rates in the American Women’s Health Initiative study did not decline when woman stopped HRT at the end of the study. A decrease in breast cancer rates has also not been seen in the UK despite a drop in HRT prescriptions.

The investigators from the American Women’s Health Initiative have recently revised their conclusions from 2002 and have found that for women aged 50-59 (the group commonly prescribed hormone therapy) there is no significant increase risk in any adverse outcome and that the benefits outweigh the risks.

The International Menopause Society also recently published a report showing that hormone therapy in women 50-59 in a safe and effective treatment of menopause symptoms and is not associated with an increased risk of breast cancer. HRT is also probably the most effective therapy in preventing osteoporosis related fractures in this age group. This study does not in any way alter these conclusions.

My advice to women taking HRT for symptoms is that this report should not in any way change what they are doing. Women under the care of a practitioner should review their reasons for being on therapy every year as a matter of course. Women around the age of 50 who are contemplating HRT for moderate to severe menopause symptoms should be strongly reassured that it is a safe and effective therapy and that in the first 5 years there is no increase in breast cancer risk.”

Professor Anne Kavanagh is Director of the Key Centre for Women’s Health in Society at the University of Melbourne.

“This study suggests that the decrease in the use hormone replacement therapy in Australian women over the age of 50 years is associated with the reduction in breast cancer incidence and is consistent with international evidence. HRT use, particularly combined use of oestrogen and progesterone therapies, is associated with an increase in breast cancer incidence and once women stop taking HRT this risk drops down to the average risk in the population.

A randomised control trial, released by the Women’s Health Initiative in 2002, showed that HRT use was linked with increases in the risks for breast cancer, coronary heart disease, thrombosis and stroke among women using HRT. Heavy media coverage of this trial was soon followed by a significant drop in HRT use worldwide. The decreased rates of observed breast cancer observed in Australia since that time are consistent with the drop in HRT use by Australian women.

Australia needs to develop a comprehensive database of prescription drug use, including HRT use, and to collect more information on the types of breast cancers that are diagnosed. Hormone therapy use is associated, in particular, with an increase in the risk what we call of oestrogen receptor positive’ breast cancers, but this information is not routinely collected by cancer registries. The information on HRT use and breast cancer incidence and mortality could be linked and this data could then be used to aid our understanding of the impact of hormone therapy on breast cancer incidence and mortality in Australian women.”