Doctors in Germany should drastically reduce the amount of hormone replacement therapy (HRT) that they prescribe to older women, a key commission has recommended.
Issuing its first guidelines on HRT to doctors in Germany, the country's Commission on the Safety of Medicines said that new international studies had shown that the risks of HRT clearly outweighed the benefits.
It recommended that doctors offer the treatment only to women with particularly severe menopausal symptoms. It also recommended that treatment be as short, and the doses as low, as possible.
Several recently published studies have shown that HRT significantly increases the risk of breast cancer. Also, the risk of venous thrombosis, heart attacks, and strokes increases as early as one year after treatment, according to the studies.
In the opinion of the commission, the new studies show that the risks of HRT far outstrip the benefits, which include lower rates of colon cancer and a reduction in the number of fractures.
Professor Bruno Müller-Oerlinghausen, the head of the commission, called HRT a “national and international tragedy.” Comparing it to thalidomide, a drug that caused thousands of babies to be born with birth defects in the 1950s, he said that the “naive and careless use of a medication that is perceived as natural and optimal” had caused many unnecessary deaths among women.
Professor Eberhard Greiser, of the Institute for Prevention Research in Bremen, said in an interview with the state health insurance press service that the use of hormone replacement therapy had resulted in 5000 extra cases of breast cancer in Germany every year and 2000 extra cases of cancer of the uterus (http://212.227.33.34/bv/bundesvb/presse/tba/medizin/977632.html).
The commission also launched a fierce attack on the pharmaceutical industry, suggesting that it had turned a “natural phase of life,” the menopause, into a hormonal sickness that needed treatment.
Forty three per cent of all women aged 50-70 years in Germany take hormone preparations.
However, the number of prescriptions that doctors issue for hormone preparations has fallen by 13% in the wake of the recent debate on the risks of the treatment, according to figures from the German state health insurance companies.
The women's health initiative study showed that the long term use of HRT increased the risk of breast cancer by 26% but reduced the risk of a fracture by 34%. (JAMA 2003; 289: 3243-53).