Hormone replacement therapy (HRT) reduces women’s risk of an early death – according to new research from the University of East Anglia.
A new in-depth study found that for healthy women taking combined HRT, the overall risk of death from all causes is reduced by an average nine per cent.
For healthy women taking oestrogen-only therapy, the risk of death from all causes remains neutral.
HRT replaces the hormones lost when a woman goes through the menopause, and it can relieve symptoms such as hot flushes, night sweats and depression.
The study, commissioned by the Institute and Faculty of Actuaries (IFoA), is the first to look at the impact of HRT on overall life expectancy using UK primary care data.
It comes as Labour MP Carolyn Harris is introducing a private member’s bill to change legislation so that women in England would not have to pay for HRT. The bill is due to receive its second reading on October 29.
Prof Nick Steel, from UEA’s Norwich Medical School, said: “HRT use has been controversial for many years, as it offers symptomatic relief to many women but there have been conflicting reports about the long-term risk of breast cancer, as well as possible benefits to cardiovascular health.”
The study followed 105,199 healthy women aged between 46 and 65 at first HRT prescription over up to 32 years with an average follow-up of 13 years. It compared their outcomes with 224,643 non-users of the same age and GP practice.
Most previous studies adjusted for demographic and/or lifestyle factors only. The UEA research went much further, also adjusting for type 2 diabetes, hypertension and its treatments, coronary heart disease and oophorectomy/hysterectomy status, as well as body mass index, smoking and deprivation status.
Prof Steel said: “It’s exciting that this new research found that combined HRT use was linked to an overall lower risk of death, and that oestrogen-only HRT was not linked to an increased risk of death.
“UK primary care data has now enabled long term follow-up of thousands of women in the UK, comparing the overall risk of death over many years for those using HRT with those not using it.”
Prof Elena Kulinskaya, from UEA’s School of Computing Sciences, said: "Despite the effectiveness of HRT in relieving menopausal symptoms, many symptomatic women are not willing to receive HRT because of the controversial results on its risks and benefits.
“The untreated menopausal symptoms eventually increase the risks of other health conditions, such as osteoporosis and cardiovascular disease, and incur additional costs to the healthcare systems.
“All-cause mortality is the crucial endpoint that essentially summarises the net effect of HRT but was rarely analysed in the past. "
Postgraduate researcher Nurunnahar Akter, also from UEA’s School of Computing Sciences, said: “Our new findings that oestrogen-only HRT has no impact on all-cause mortality and combined HRT reduces the risk, confirm that the overall benefits of HRT outweigh the harms and should be provided to women and to clinical decision makers when they are deciding whether to start or continue HRT.”
Louise Pryor, IFoA President, said: “This study supports the emerging consensus that, for most women, the benefits of HRT outweighs the harm. We hope this research will help to inform the debate as the private member’s bill is considered in Parliament and also, support women deciding whether to start or continue with HRT.
“Delving into these complex, long-term, multi-faceted issues is where the IFoA’s Actuarial Research Centre can really add value. It provides a valuable lens for exploring some of the most pressing social and policy challenges of the 21st century through credible, evidence-based insight and analysis in the public interest.”
‘The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017’ (preprint) has been accepted in BJOG: an International Journal of Obstetrics & Gynaecology.