Recommendations about HRT are currently being considered following the recent Lancet study into breast cancer risk and HRT.7

NICE had announced in the spring of 2019, that it was not proposing to update its 2015 guideline NG23 on diagnosing and managing menopause. Having reviewed 122 papers, it said: “New evidence did not suggest that an update of the guideline is needed to consider additional risks or benefits of hormone replacement therapy.” It was inviting comments until August 30 about this decision.8

However, on August 29 2019, the Lancet published a review based on studies using data from over 108,000 women. In essence, this confirmed that women who use HRT for longer than one year have a higher risk of breast cancer than women who never use HRT.7,9

The study prompted the Medicines and Healthcare products Regulatory Agency (MHRA) to issue a Drug Safety Update, which highlighted study findings including:7,10

·       there is little or no increase in risk with current or previous use of HRT for less than 1 year; however, there is an increased risk with HRT use for longer than 1 year;

·       all systemic (oral or transdermal) HRT is associated with significant breast cancer risk;

·       there is no evidence that low doses of oestrogen applied intravaginally to treat local symptoms increase breast cancer risk;

·       risk increases steadily with the duration of use;

·       risk declines after stopping HRT, but there is still an elevated risk of breast cancer 10 years later compared to never having used HRT;

·       risk is greater for oestrogen-progestogen combinations than oestrogen-only preparations.