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Update to ADEC statement on use of hormone replacement therapy

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17 October 2003

This document should be read in conjunction with the ADEC STATEMENT ON USE OF HORMONE REPLACEMENT THERAPY dated 14 August 2003.

In October 2003 the Australian Drug Evaluation Committee reviewed the available information on the use of hormone replacement therapy (HRT).

In the light of the recent information on long term effects of HRT, the Committee concluded that the use of HRT for any long term disease prevention cannot be generally justified as the potential harm may outweigh potential benefits. This concern applies also to the use of HRT to prevent osteoporosis.

The potential risks from long term use of HRT include increases in heart disease, breast cancer, and blood clotting leading to an increased risk of stroke. In the long term studies these risks were not outweighed by the benefits such as prevention of fractures and of cancer of the bowel. Although these risks were strongest for combination HRT involving use of an oral oestrogen and progestogen data show use of any hormone replacement therapy, including use of oestrogen alone or transdermal preparations, is associated with some increase in risk including that for breast cancer.

HRT has an established place in the short term management of symptoms of the menopause. For treatment of established osteoporosis, the selection of HRT by the patient and doctor should be based on a careful consideration and discussion of risks and benefits for that individual.

The Chair of ADEC, Professor Martin Tattersall, emphasised that women should not suddenly cease HRT, but should make an appointment with their doctor to discuss the expected risks and benefits of HRT and other treatment options in their individual circumstances. Professor Tattersall reinforced the fact that women who have an intact womb should not generally take oestrogen-only HRT.