26.11.2022

What IS the truth about claims that HRT fights dementia and heart disease?

Before speaking out last week about the menopause revolution, I was, I’ll admit, apprehensive. I’ve been targeted by HRT campaigners before. It feels like every time I write about evidence-based menopause treatment, they accuse me of being ill-informed, even spreading misinformation.

That it happened again was predictable. After all, I was talking about my fear that some women were being encouraged by celebs and private doctors to take HRT they didn’t really need.

I went as far as to say the relentless focus on the negative aspects of the menopause amounted to scaremongering and made women think it would always be hellish, when in fact it is not.

This didn’t go down well with Davina McCall, who has become a tireless advocate for HRT after her own positive experience.

She wrote on Instagram that my article was ‘factually inaccurate’ – but wouldn’t say much more.

Feel free to get in touch, Davina, if you find something that needs correcting.

Before speaking out last week about the menopause revolution, I was, I’ll admit, apprehensive. I’ve been targeted by HRT campaigners before. It feels like every time I write about evidence-based menopause treatment, they accuse me of being ill-informed, even spreading misinformation, writes Dr Ellie Cannon

Sexual health expert Samantha Evans, a former nurse who featured on Davina’s C4 documentary, Sex, Mind And The Menopause, weighed in too: ‘Dr Ellie Cannon often gives incorrect menopause advice in the Mail… she seems to really dislike the menopause community.’

These comments – and there were many more like them – seemed to ignore the fact that I argued for a nuanced, individualistic approach that might include HRT and might not.

As I said, they weren’t unexpected. But this time something else happened, too. There was a huge groundswell of support from the medical community and women in general.

I received numerous messages from doctors who admitted they shared my concerns. There were posts online from patients who said they felt ‘guilty’ or ‘anti-feminist’ for not taking HRT in this new era of medicalising menopause, and a torrent of emails from readers with similar views, all of whom applauded The Mail on Sunday for highlighting what has become a highly contentious issue.

On Twitter, University College London’s Professor Joyce Harper, a leading voice on women’s health, wrote: ‘I think we’ve got ourselves in a mess with HRT. Yes it’s terrific for some women. But not all women need or want it. And some can’t take it. I agree with Dr Ellie.’

She later added: ‘Many women don’t want to take HRT and we shouldn’t be guilted into it.’

Davina McCall (above, at a rally outside Parliament) has become a tireless advocate for HRT after her own positive experience. She wrote on Instagram that my article was ‘factually inaccurate’ – but wouldn’t say much more. Feel free to get in touch, Davina, if you find something that needs correcting

Catherine Harland of the Menopause Mentor website added: ‘It’s no wonder women are confused thanks to the conflicting menopause narrative. There’s evidence-based info and then there’s scaremongering. It makes me livid.’

And nutritionist Jackie Lynch wrote that it ‘echoed many of my thoughts,’ adding: ‘I’m concerned about the fearmongering messaging around the menopause. While HRT can be life-changing for some, it’s not appropriate for everyone, nor the panacea it may seem.’ I couldn’t agree more.

Lots of people pointed out, too, that my article did not mention the long-term benefits of taking HRT – and there was a reason for this.

Social media has been awash with claims that these drugs, which top up levels of the female hormones oestrogen and progesterone, can stave off some of the worst diseases of ageing.

Campaigner Kate Muir, who produced Davina’s documentary, wrote on Instagram that my piece ‘fails to understand the long-term benefits of body-identical HRT [a common form prescribed on the NHS] – reducing osteoporosis, colon cancer, type 2 diabetes, heart disease and dementia.

‘Not recognising that HRT can give women a healthier and less pain-filled later life is either ignorance or medical gaslighting.’

It’s claims such as these that have, undoubtedly, ignited business for the country’s private menopause specialists. It’s impossible to know how much the industry is worth today, but one very vocal menopause GP, Dr Louise Newson, has admitted she has a waiting list of more than 8,000 women at her Newson Health practice. An initial appointments there is £295. I’ll leave you to do the maths.

Dr Newson told a webinar last year for the International Menopause Society that HRT ‘reduces the risk of cardiovascular disease by about 50 per cent’.

She added: ‘If you compare the benefit of using a statin or blood pressure lowering drug with the numbers for risk reduction taking HRT, the one that wins is HRT.’

They are sensational claims. But how true are they?

NHS guidelines make it clear that HRT should be prescribed for severe menopause symptoms, and to younger post-menopausal women at risk of osteoporosis. A statement issued by professional bodies representing experts in menopause care – the British Menopause Society, the Royal College of Obstetricians and Gynaecologists and Society for Endocrinology – is very clear on this, too.

It says: ‘For most women, HRT has a favourable benefit/risk profile. However, HRT should not be used without a clear indication, and should not be used for the sole purpose of disease prevention.’

In other words, unless your menopause symptoms are affecting your quality of life, you should not be taking it.

Why? Well, for that we have to look at the evidence.

It’s very easy to cherry-pick studies that look like they prove what you want to hear. But the fact is that, in analysing any of the reported benefits, there’s only one study we have that is considered the gold standard – a huge American clinical trial of 27,000 women called the Women’s Health Initiative, which divided women into three groups to receive HRT in several forms: either oestrogen and progesterone, oestrogen alone, or a placebo pill.

What about the claim that HRT works better than statins or blood pressure drugs for reducing heart attack risk? It’s just not the case. As I’ve said, there’s some evidence that HRT might provide some protection, but hundreds of clinical trials have shown the same thing: statins and blood pressure drugs reduce the chances of suffering a heart attack and stroke for pretty much whoever takes them, says Dr Ellie (pictured)

It began in 1992 and has been following women up ever since. And it’s good news when it comes to bone health. For women with osteoporosis, fractures were a third less likely in those treated with either oestrogen HRT alone or oestrogen plus progesterone.

But the picture with everything else that’s claimed is murkier.

Let’s start with the cardiac benefits. There’s no doubt menopause is bad news for the heart. The drop in oestrogen levels changes the way we store fat, which increases women’s risk of type 2 diabetes and heart disease. And it can cause insomnia, again a risk factor for heart problems.

The question is, can HRT protect against these changes?

The answer is yes, in women under 45 who have a premature menopause due to illness or a hysterectomy. But analysis by medical review body Cochrane Collaboration found in women aged 50-59 who took HRT, ten in 1,000 ended up with heart disease, compared with 18 in 1,000 in those who did not take HRT.

It’s a fact

One hormone replacement therapy drug, called Premarin, is produced from the urine of pregnant horses.
The body produces three main types of oestrogen: estradiol during reproductive years, estriol during pregnancy and estrone after menopause.

The authors say it’s too small a difference to mean anything. Women on HRT in this age group were also more likely to have blood clots – 11 in 1,000 compared with six in 1,000 not taking HRT.

And the older you are, the fewer those heart-related benefits and the greater the risk of strokes and blood clots – a risk that increases the longer you stay on HRT, the Cochrane study found.

More recent evidence suggests these risks are greatly reduced if you take oestrogen alone as a patch or gel, but we don’t have a long-term picture for these drugs.

Obviously, if you’re struggling with severe symptoms, HRT will be life-changing. But experts agree: you should not take HRT just to stave off heart disease.

What about the claim that HRT works better than statins or blood pressure drugs for reducing heart attack risk? It’s just not the case.

As I’ve said, there’s some evidence that HRT might provide some protection, but hundreds of clinical trials have shown the same thing: statins and blood pressure drugs reduce the chances of suffering a heart attack and stroke for pretty much whoever takes them.

There is no comparison, and frankly I and many of my medical colleagues have been horrified that a doctor would suggest it. As one cardiologist told me: ‘HRT is not going to lower blood pressure and it won’t prevent a stroke.’

It’s the same problem with claims about HRT staving off type 2 diabetes. Lots of clinical trials have suggested it might delay the onset of the disease by protecting against the accumulation of fat around the middle – a risk factor for type 2 – but also improving how the body uses insulin.

Kate Muir’s book Everything You Need To Know About The Menopause cites a review of the evidence to back up this claim – but that study makes it clear HRT should not be used to protect against diabetes.

Another big claim is that HRT staves off dementia – a feature of Davina McCall’s documentary. She refers to a US study of 400,000 women that found those using HRT were 58 per cent less likely to develop Alzheimer’s. But the study should be read with caution: women who can afford HRT in the US private health care system are wealthier, healthier and less at risk of dementia.

And in 2002, women with any form of heart disease or risk factors for heart disease were advised not to take HRT. This was because some evidence – now disproved – appeared to show it could increase heart problems.

Heart disease also raises the risk of dementia. So those studied – a group with healthier-than-average hearts – will have already been at much less risk of Alzheimer’s.

Another study cited, KEEPS (Kronos Early Estrogen Prevention Study), looks at the effect of HRT on the brain and the development of tell-tale plaques that can be a signature of Alzheimer’s. It found HRT may preserve brain volume and lead to fewer plaques.

Although interesting, it’s too early to make conclusions as no participants have dementia – and plaque doesn’t always lead to the disease.

The Women’s Health Initiative study also looked at dementia risk but found nothing significant.

Science moves on. Regulators adapt to new evidence. Perhaps the benefits above will be proven by solid, long-term data.

Perhaps newer formulations of HRT will be found less risky.

We just don’t know that for certain, yet. For now, my best advice is that any women taking hormone replacement therapy and hoping for the elixir of eternal youth may end up disappointed.

It was the best thing that ever happened to me! MoS readers on how they coped…

I was delighted when I reached the menopause aged 50 – no more messy periods, no spoilt holidays, freedom to swim and sunbathe. The minor inconvenience of hot flushes soon disappeared with the help of liquorice tea.

Women will never be taken seriously if they are constantly bleating about ailments, demanding HRT and special concessions at work because of a totally natural, and indeed liberating, interlude.

The hysteria about HRT shortages reminds me of addicts deprived of their heroin. No one ever died of the menopause; it’s a positive step, not a negative one, and expensive NHS medication is entirely unnecessary.

Elizabeth Lowe

I went through the menopause in my late 40s while working full-time as a hospital doctor, with two teenage sons.

Like many professional women I knew, I took HRT for about three years, as I suffered insomnia and it helped me sleep.

The medication served its purpose, and when I didn’t feel I needed it any longer, I stopped.

Name withheld

When I was thrust into the menopause at 47, I had numerous unpleasant symptoms that ebbed and flowed but just didn’t go away.

At my lowest point a male GP unhelpfully told me I was lucky to be alive as women in times gone by died before they even got to the menopause.

Aged 55, I’m now pretty much through it all. We need menopause policies, research and understanding and a society that acknowledges that every woman’s menopause is unique.

Lynda Sullivan, Isle of Man

I have friends who had an awful time with the menopause, and they rightly had medical help. But I and the majority women I know have gone through this period with no need for medical intervention.

Name withheld

When my daughter, now 49, asked me recently how I managed the change, I had to say I can’t remember, so it couldn’t have been that bad!

Elizabeth Millar

Two years of horrendous sweats, day and night, and joint pain finally led me to my GP. She was reluctant to give me the HRT patches I asked for, but I persisted.

Having been on them for almost a year, I no longer need painkillers and the sweats have diminished. I feel well and happy.

Everyone is individual. Do your research before you discuss the menopause with your GP, who may have only vague knowledge on the subject.

Name withheld

I had a hysterectomy when I was 44 and was not offered HRT. I was told that my body would make enough oestrogen and, as I was fit and healthy, I would be fine.

This proved to be correct as I continued to work until I was 67 and never took sick leave. I did get a few night sweats, felt depressed and a bit anxious, but that is part of life.

My job was causing stress, so I changed that, and worked on resolving family difficulties.

This stage in life is inevitable. You will also pass through it, as I did, older but wiser.

Hazel Horsnell, West Worthing

A lot of women suffer with hot flushes, but my thoughts have always been: ‘I’m hot, so what? There are worse things and it will pass.’

The menopause is a normal stage in life we have to go through. HRT has helped a huge number of women but it is postponing the inevitable.

Anne Williams

I am 71 and went through the change at 50 with just the odd warm flush.

In a survey of my friends, only one took HRT due to real issues during the process. My mother said when I started my periods, ‘You are not ill.’ I had the same attitude to the menopause.

Jill Liddell

I started experiencing hot flushes and disturbed nights about 20 years ago, aged 46, just as my periods were fading out.

HRT didn’t agree with me – my mental health suffered – and natural remedies just made my legs swell. So I learned to live with it.

I still get the occasional hot ‘flash’ but I manage this with aromatherapy rollers – applied to my temples, in front of my ears, and on my wrists – when things get a bit sticky.

Sally Heavens, Louth

The menopause happened for me at pretty much the same age as it did for my mother, in my mid-50s.

I might have been a bit more ratty but did not suffer most of the more difficult symptoms that I read about.

The main inconvenience was having very heavy periods for the last couple of years, but after that I rejoined the human race to enjoy a wonderful period-free future. My next birthday will be my 80th.

Carole Stimson

I was 49 when my periods just stopped and all I experienced was hot flushes for a year – this was great for me in the winter as I feel the cold and I had an in-built heater!

My periods used to leave me anaemic. The menopause is the best thing that has ever happened to me.

June Cavender

My menopause started when I was 51 and working full-time while looking after my mother, who had dementia.

At that time, HRT was the big new thing, but it was then made from horses’ urine, so I refused it.

Instead I wore cardigans that I could open when I felt too hot. I suffered electrical charge-like sensations down my arms and legs and struggled to sleep. After my mum died when I was 60, the symptoms slowed down.

There seems to be an obsession with HRT these days and women think they won’t be able to manage without it. Well, I did.

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