Menopause symptoms are often debilitating affecting personal, social and professional quality of life. Hot flushes are among the most disturbing symptoms in menopausal women. Currently the most effective treatment for hot flushes is HRT (hormone replacement therapy), which reduces symptoms by up to 80% compared to pre treatment. However long –term use of HRT has been reported to be associated with increased risks of cancer and stroke.

Journal of Family Planning and Reproductive Health Care (April 2013, Vol 39, Issue 2)

Does hormone replacement therapy (HRT) cause breast cancer? – Commentary by Nick Panay (currently Chairman of the British Menopause Society)

Young women with premature menopause also require HRT for primary prevention of osteoporosis, cardiovascular disease and dementia.

Following the results of three studies, the Collaborative Reanalysis (CR), the Women’s Health Initiative (WHI) and the Million Women Study (MWS) it has been claimed that HRT is an established cause of breast cancer.

The WHI and MWS had a profound effect on the prescribing of HRT ….. Prescribing declined by more than two-thirds……

Women were left feeling confused and at times terrified by alarmist headlines. This was illustrated by a survey through the Menopause Matters website where 70 % of women who came off their HRT were aged less than 50 years old and given current knowledge 45 % would not have discontinued therapy.

The commentary quotes from work done by Shapiro and colleagues who looked for evidence of bias and biological plausibility to assess the CR and MWS findings. Their analysis highlighted several design flaws that would potentially have skewed the findings. They concluded that “HRT may or may not increase the risk of breast cancer, but the CR did not establish that it does”. In their subsequent critique of the MWS they went on to state that “the evidence was unreliable and thus the only effect of its massive size was to confer spurious statistical authority to doubtful findings”.