The Journal of the American Medical Association (JAMA) recently published the results of an 18-year follow-up of two randomized clinical trials that assessed the risk of death between women who took Hrt pills after menopause and women who did not. The results of this follow-up showed that the mortality risk of women who took the pills was not higher than the placebo group, despite the HRT group presenting with more cases of breast and ovarian cancers, as well as strokes during the trials.

Why do women take HRT treatments after menopause?

Women who go through menopause experience a drop in hormones such as estrogen, progesterone, and even the "male" hormone, testosterone.

The drop in the levels of these hormones can cause women to have symptoms such as mood swings, hot flashes, night sweats, vaginal dryness, atrophy, and can put women at greater risk of developing osteoporosis. HRT treatments can help women manage these symptoms during this period by restoring the body's hormone levels. Treatments to relieve symptoms can be localized such as the estrogen vaginal ring for vaginal dryness. Or, if necessary, the treatment can be systemic like the pills prescribed during the trials. Localized hormonal treatments are thought to have lower risks than the systemic treatments.

How the trials and follow-up took place

The two trials occurred between 1993 and 1998 in the US and the women studied were aged 50 to 79. One clinical trial studied the risk of death in women who took estrogen-only pills versus a placebo, and the other studied that risk in women who took the combined estrogen-progestin pills versus a placebo.

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The median time for women who took the different pills was 5.6 and 7.2 years respectively, and so the follow-up concluded that women who took HRT pills for five to seven years are not at risk of earlier death. Both groups were followed up for 18 years and the findings from both studies were pooled together to compare the mortality risk of all women who took HRT pills with all who took placebos.The results showed that the overall rate of mortality in both groups from illnesses such as breast and ovarian cancers, cardiovascular disease, along with other factors was nearly the same: 27.1 percent for the HRT group and 27.6 percent for the placebo group.

Why are these findings significant?

As the trials flagged up the increased risk of breast and ovarian cancer, as well as cardiovascular disease, there has been a general concern amongst menopausal women and their doctors about how much the benefits of treatment outweigh the risks.

The methodology amongst several doctors has been prescribing the lowest effective dose for the shortest duration possible.

Doctors also refrain from prescribing the treatments to women who have previously had breast and ovarian cancers as well as strokes, as taking estrogen increases the risks of having those diseases. Women are generally advised to discuss treatment options with their doctors. Although several experts already agree that HRT is a good and effective choice for some women, these findings are thought to reaffirm that stance and give a more reassuring view about long-term effects of treatment.