Abstract
In a previous issue of this journal, our editorial, Estrogen deficiency: Education for all, 1 emphasised the importance of education about the continuum of effects of estrogen deficiency, both short, intermediate and long term for all healthcare professionals caring for estrogen-deficient women and the need for a broader life-course approach. Has our message been heard and have we learnt? From articles in this issue,2,3,4 it appears not with concerns raised from primary care and sexual health trainees, clinicians who frequently care for estrogen-deficient women.
To add to this concern of apparent continuing lack of education and understanding of the importance of post-reproductive health among healthcare professionals, the recent media frenzy around a publication in The Lancet 5 has simply added to the confusion portraying risk of ovarian cancer with use of hormone replacement therapy in an alarmist and sensational fashion where, even if risk does exist, is extremely small. The details of what this recent report actually showed and, more importantly, did not show, will be examined in a future issue of Post Reproductive Health but early assessment of the data concludes that the studies which were included were observational and so cannot prove causality, the highly publicised figure of an increase of risk of ovarian cancer of 40% in women using HRT for five years from around the age of 50 equates to an extra one case per 1000 women taking HRT for five years, a figure which, according to Sam Shapiro, is of no material significance in public health terms.
Recent studies have increasingly confirmed previously believed significant benefits of HRT, not only in reduction of menopausal symptoms but also in improvement of bone health, and reduced cardiovascular risk and mortality when HRT is started early. The massive media attention paid to the negative feature from the recent publication failed to address the balance between risks and benefits and no doubt has caused many women to be alarmed needlessly.
While not all women require HRT, it is an option and, when used appropriately, provides more benefits than risks for the majority of women under the age of 60, and for many beyond that age. The level of publicity seen around this extremely small risk, which may not in fact be due to the use of HRT, only serves to prevent women from being able to make a truly informed decision about the management of their menopause.
So where does this leave us? We can conclude that there is much to do to provide education for healthcare professionals and a series of events are being organised by and in conjunction with the British Menopause Society for 2015 throughout the UK. We do hope that these events will be well attended and that those who do attend will spread the word, sharing the learning with colleagues. Further, there is much to do to address the balance in providing factual information through the media without being alarmist. It is clear that the topic of menopause and particularly HRT is “sexy” and attracts readership and that sadly, only bad news is good news.
We can only hope that the NICE guidelines on Diagnosis and Management of Menopause, due to be published October 2015, which will provide agreed clarity, will receive the same level of media attention and that both healthcare professionals and women can make truly informed choices at last!