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[dahliagirl]

http://www.theguardian.com/society/2015/nov/07/scientists-fear-pr-campaign-underplays-hrt-cancer-risks

Not wishing to open any worm cans, but this will probably interest those who are following the debate.

It does not give anything new but it is interesting that groups are lining up to oppose/promote their interests in the run up to the publication of the new guidelines.

As a menopausal woman, I do not find it helpful - you are just left blowing in the wind between the self interests of various groups, and not getting any help.

Yours despondently 

[Mary G]

Thanks for the link, I have just read it and it doesn't worry me in the slightest, in fact I would go as far as to say it confirms what I have always thought which is HRT is a life changing drug that is safe, particularly if both the oestrogen and the progesterone used are bio identical. 

Nothing that Beral says has any creditbility because she was linked the hugely discredited million women and does not want to admit to being wrong.  Her research is mostly funded by the taxpayer and she has a vested interest in not being wrong and also to keep churning this stuff out, it is very lucrative. 

There is a lot of bad epidemiology about and I would urge everyone to be very careful of so called stats and studies, all of which conflict with each other and are unlikely to offer any clarity on this or any other subject.  This is an example of the type of logic often used in scientific studies and I think it is referred to as linear risk extrapolation i.e. assuming that things are definitely deadly and there are no safe thresholds:

"If a million people cross a body of water 10 feet deep and 100,000 drown then 1,000 would drown if the water were an inch deep".

[dahliagirl]

I agree with you about Beral.  It must be hard to watch something you have worked on taken apart strip by strip, but the study did not produce any causal link, and the statistical link is not certain once it it looked at.

I just hope that in doctors' surgeries, the new guidelines are acted upon.  Really, the doctors who have produced the guidelines have taken into account all these studies to produce something that is best practice.

[Hurdity]

Hey dahiagirl - thanks for that - I was going to post the same but you beat me to it!! It was in our hard copy of weekend Guardian. Even my husband said to me - there's an article about HRT in there! Now that really is something  !

Do have a read of this too:
http://www.medscape.com/viewarticle/853548

As I pointed out at the time everyone (Press, women on here, everyone everywhere) was up in arms about the research and its failings without having read it - the study clearly was not designed to evaluate the safety of HRT (as if it would be with a sample size that small) but was a very detailed interesting study looking at something else of which a subsidiary finding was that no-one developed the cancers of concern. They were looking at body fat mass, lean body mass and BMI but looked at a number of other things along the way too.

I agree about the bad science. I don't really like meta-analyses which are often cited (eg the big one about ovarian cancer risk and HRT) because of the lumping together of totally dissimilar studies and drawing conclusions, not to mention the lumping together of outcomes using different HRT typoes.

It's like saying - let's study painkillers and lumping together every study that uses aspirin, and ibuprofen and applying the conclusions to paracetamol - because it's a painkiller - well that's how I see it anyway. Science is very specific and many of these statistical risk studies just confuse the issue and especially when reporting risk as you say Mary G. What really gets me is the correlation/causation thing - the most fundamental error in science. eg drinking ground coffee is associated with longer life expectancy therefore drinking ground coffee will extend your life. I made that one up but it's the argument used so often!

Hopefully the guidelines will be used sensibly!

Let's not forget the increasing life-expectancy of women who might spend 40 years or more in a post-menopausal state.

Hurdity x

[ancient runner]

I might be being thick here, but there's been talk of new NICE guidelines coming out imminently... anything happened yet??

[dahliagirl]

http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0639?

Nice just says 'November 2015' 

The Guardian article says 'next Thursday'.

[oldsheep]

From the comments below the Guardian's scare article, seems that some people believe the story entirely and think that big pharma is pushing HRT. Obviously none of the commentators has read much, and none seem to have been through or are going through a really bad menopause.
There's quite a lot of fairly dismissive talk aimed at Mr Panay and the BMS too, which I'm surprised they haven't reacted to (or maybe they think keeping quiet works better).

I'm vague on the Million Woman Study but think it was based on synthetic hormones entirely? (as well as other issues with it). I suppose the study's sheer sample size is enough to convince some people. I just hope that NICE doesn't go nasty on HRT (as they've done with certain other drugs, on clinical or cost grounds). The cynic in me says every menopausal or post meno woman on HRT would cost the NHS too much!

[Hurdity]

Not sure what you mean there oldsheep re NICE going nasty? Do you think the actual guidelines that are published might be totally different? I hadn't thought of that - I assumed it would be minor tweaking - after all they are an expert group that have been meeting for a long time. How naive am I?! Maybe the actual GP practices ( I am hazy about how these are funded now compared to hopsitals?) will be up in arms about the cost?  As they stand the draft guidelines are very favourable.

The MWS was using Conjugated Equine Oestrogens (the pregnant horse pee stuff) - which does contain estradiol but some much stronger ones too that we dont have. The progestogen was synthetic - I think it was MPA? So not comparable at all in my opinion - however large!!!

Hurdity x

[Mary G]

Spot on Hurdity, the MWS did use very outdated medication that is not only ineffectual but heavily laden with counter productive progestins.  In my opinion, there is no comparison between the old school, heavy duty, oral HRT and the transdermal bio identical products available today and they cannot, and should not, be compared. 

NICE should take this into account before producing their new guidelines and taking things a stage further, I would hope that transdermal, bio identical oestrogen and Utrogestan progesterone (vaginal route) become the first port of call for GPs when prescribing HRT in future.

[Limpy]

NICE should take this into account before producing their new guidelines and taking things a stage further, I would hope that transdermal, bio identical oestrogen and Utrogestan progesterone (vaginal route) become the first port of call for GPs when prescribing HRT in future.

Mary G - I'm sure the bio identical regime you mention really would be good - but surely getting GPs to accept that HRT, any HRT at all, could be more helpful to menopausal women than no HRT whatsoever, would be a useful objective?

[dazned]

Well I am unfortunately very cynical 

As having friends and family in the NHS have told me NICE are guidelines only ,gps do not have to abide by them 

Again when each surgery practice manager starts waving the balance books under the Dr s noses all sorts can happen !
I naively thought that whatever my consultants prescribed the gp would have to as well,how wrong was I !

[oldsheep]

Yes, I remember the good old days when a GP routinely followed a consultant's advice. I think that changed when they started to manage their own budgets more (?). They do pick and choose how individually to treat a patient when it comes to NICE guidelines too. I can't work it out sometimes 

I hope the article means that NICE will come out as broadly in favour of HRT, particularly the bio identical kind. That might help with GPs as so many women I talk to say their GP has told them HRT is dangerous.  My own GP says he knows nothing about HRT so follows the menopause clinic advice as long as (for eg) I don't have high bp in which case he'll start chuntering....
My worry is that NICE put a time limit on how many years you can be on HRT. I can imagine 5 years being all you're allowed, which is a big worry. The meno clinics seem happy to keep you on it provided you are doing ok.

[CLKD]

GPs should remember that they are GPs because  ………. that's the route they choose because they were interested in over-all health or they weren't clever enough to become Consultants ……………

I want a GP who will discuss the pros and cons and leave me to take any associated risks.