HRT does not affect life expectancy

Hormone replacement therapy (HRT) does not shorten or extend the life expectancy of those who use it to relieve menopause symptoms, health rating body NICE says in updated guidance.

The conclusion comes after a detailed analysis of data on the link between HRT and conditions such as heart disease, stroke, some cancers and dementia.

The guidance includes a new discussion tool to help GPs give their patients the most useful information about the medicines and what they do.

And it says talk therapy can be offered alongside HRT to help women cope with symptoms.

HRT replaces the hormones estrogen or progestin, or both, when women’s periods stop – normally between the ages of 45 and 55.

It is administered using gels, creams, pessaries, tablets or sprays.

In updated menopause guidance, NICE (the National Institute of Health and Care Excellence) says healthcare providers should take into account a woman’s personal situation and provide all the information needed to help her make the best choice of treatment .

The guidelines emphasize that although there are some increased risks associated with using HRT, it is unlikely to extend or shorten overall life expectancy.

Easy-to-read illustrations are shown of the likelihood of certain health problems developing. These are intended to help GPs have informed conversations with patients.

Dr. Marie Anne Ledingham, NICE clinical advisor, explained that an independent panel reviewed the available scientific evidence to come up with the information.

She said the risk of coronary heart disease, stroke and ovarian and endometrial cancer was no higher in women aged 45 and over who used combined HRT, compared with those who had never used it.

And HRT actually reduced the risk of fractures related to the bone condition osteoporosis, which is more likely to develop after menopause.

But the risk of breast cancer for women has increased slightly, with consequences for:

• 59 in 1,000 women never use HRT

• 79 in 1,000 taking combined HRT for five years from the age of 50

• 92 in 1,000 use combined HRT for 10 years

The risk of dementia was also slightly higher if women started HRT after the age of 65. In younger patients there was no increased risk of developing dementia.

“The risks are very low in the population, and HRT can provide enormous benefits at a very difficult point in many women’s lives,” said Dr. Ledingham.

The guidelines are clear that HRT is the best treatment option for hot flashes and night sweats caused by menopause.

Talking therapy, known as CBT (cognitive behavioral therapy), should be offered to women over 40 in addition to HRT or, if the patient’s individual circumstances require it, instead.

This is a change from the draft guidelines published at the end of 2023 causes controversy by suggesting that talk therapy could replace HRT as a treatment.

The level of feedback NICE received at this point led to a longer than usual delay in issuing the final guidance.

Have prescriptions for HRT grown considerably in recent years in Great Britain.

Professor Jonathan Benger, chief medical officer at NICE, said awareness of the impact menopause symptoms can have on women has increased in recent years.

But he said more could be done to improve support for women from minority ethnic backgrounds and from poorer areas “who are often unaware of or unable to access treatments that could help them”.

“Women need to be able to trust that they are getting advice and options that meet their needs, and that they are supported to make the choices that are right for them,” said Prof. Benger.