Is HRT dead? | |
Hormone replacement therapy and the menopause. Michael S Marsh and Juliet E Compston (editors). London: Martin Dunitz, 2002 (182 pp). ISBN 1 85317 691 5. |
Is hormone replacement
therapy (HRT) dead? Definitely, according to the lay media, following the release of the adverse outcome data on breast cancer, coronary artery disease, strokes and thromboembolic disease from the Women's Health Initiative (WHI) study in the United States. Definitely not, if one looks at this book. While its publication preceded the WHI results, it does collate the scientific data underpinning the medical interest in the application of female sex hormones in many conditions. With contributions from one American and 15 British academic clinicians in wide-ranging fields, including gynaecology, urogynaecology, cardiovascular disease, metabolic bone disease and psychiatry, the book provides an up-to-date literature survey in these specialist areas. Prudently, the authors’ clinical recommendations in favour of HRT are cautious, and acknowledge the weakness of the epidemiological data on the safety of long term use. A succinct introductory chapter gives clear guidelines for clinical management of HRT from patient selection to assessment and monitoring, as well as strategies for dealing with common problems. Unlike the other contributors, these authors do not discuss the evidence base for their recommendations. Some topics of particular interest to women and their general practitioners are not covered in the book, for example effects on skin and connective tissue, libido and general energy levels. A chapter on psychological aspects deals with women’s perceptions of menopause as a transitional life stage, creating vasomotor symptoms, and anxiety and depression. Psychological remedies such as cognitive-behavioural therapy are discussed, but there is no discussion of medical management. The use of testosterone is not discussed in any detail. In view of the numerous fascinating basic scientific studies, it is clear that HRT is not dead, but its use will change considerably. The final chapter is devoted to selective oestrogen receptor modulators, and signals the probable way forward for research. Unfortunately, it is the only chapter which is unnecessarily padded with extraneous material — namely the evolutionary biology of oestrogens — of interest to some, but not relevant to the main topic. Clinicians will continue to prescribe HRT for carefully selected patients, and this book will be of interest to those seeking more information to discuss with concerned patients. Angela M Rutherford
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