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Study Confirms No HRT Benefit for Older Women

ed to the placebo group. However, rates for cerebrovascular disease, breast or other cancers, fractures and overall deaths were not significantly different in these two groups.

This study confirms an early increase in thromboembolic and cardiovascular risk in older women starting hormone replacement therapy many years after the menopause, say the authors.

It shows that there is no overall disease prevention benefit, and some potential risk, for women who start hormone replacement therapy many years after menopause.

The results are also consistent with the early findings of the WHI and other trials, and support the conclusion that combined oestrogen and progestogen therapy should not be initiated to prevent cardiovascular disease in older postmenopausal women.

However, the authors stress that these results cannot necessarily be applied to younger menopausal women starting hormone replacement therapy to relieve symptoms such as hot flushes and night sweats. For these women, recent studies suggest there may be cardiovascular benefits of taking HRT around the time of menopause. The authors say that more research is needed to assess conclusively the long term benefits and risks among these women.

Those helping women make choices about treatment should consider both the results and limitations of the WHI and WISDOM trials, particularly those women who may be influenced by the timing of initiation of hormone replacement therapy, they conclude.

In an accompanying editorial, Dr Helen Roberts at the University of Auckland says that this study does not change current advice to postmenopausal women. Healthy women in early menopause are unlikely to face substantially increased risks when using hormones for a few years, she writes. However, long term use of hormone replacement therapy to prevent chronic disease is no longer recommended as the available randomised evidence shows that the negative
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