Authors have links to manufacturers and no expertise in evidence synthesis

The British Menopause Society’s 2013 recommendations on hormone therapy (click here) is biased in favour of the wider prescribing of HT. For example:

Arbitrary limits should not be placed on the duration of usage of HRT; if symptoms persist, the benefits of hormone therapy usually outweigh the risks.

HRT prescribed before the age of 60 has a favourable benefit/risk profile.

Compare this with the UK Medicines and Healthcare Products Regulatory Agency (MHRA)’s current advice:

For all women, the lowest effective dose should be used for the shortest time.

Or the US Federal Drug Administration

If you decide to use hormones, use them at the lowest dose that helps.  Also use them for the shortest time that you need them.

The authors choice of references is also biased. For example they cite a press release from the unpublished KEEPS study as suggesting that there is no cardiovascular harm from HT begun soon after the menopause, but fail to mention these two papers in the BMJ and Lancet (click here and here) suggesting an increased cardiovascular risk.

Disappointingly, the Royal College of Obstetricians and Gynaecologists (RCOG) has endorsed this nonsense (click here) without mentioning the authors’ or the society’s conflicts. Perhaps that is because the authors of the report don’t list their conflicts either. So here they are:

Nick Panay, Lead author – consultancy, advisory and honoraria  Pfizer, Bayer, Abbott. (click here) plus Baxter, Schering, Eli Lilly, Galen, Janssen Cilag, Merck, Novo Nordisk, Novogen, Organon, Orion, Procter & Gamble, Se-cure, Servier, Shire, Solvay, Storz, and Wyeth (click here).

The trustees and council of the British Menopause Society also include:

Janice Rymer, Organon (click here) and Wyeth, Janssen-Cilag and Pfizer (click here)
John Stevenson Schering Plough, Wyeth/Pfizer, Bayer, Meda and Merck/Theramex. (click here)
John Studd, Procter & Gamble (click here)
David Sturdee, Amgen, Theramex, Procter & Gamble, Wyeth, Bayer Schering and Novo Nordisk. (click here)

There are no published conflicts of interest for the other three authors Haitham Hamoda, Roopen Arya or Michael Savvas. However, none of them have previously performed an evidence-based review.

Naive women who visit the RCOG website in search of advice about HT should be aware that the review they get directed to is written by authors with links to the HT manufacturers who have no experience of evidence synthesis.

The Cochrane Library is a better source of information. Its systematic review of menopausal hormone therapy (HT) and cardiovascular disease (click here) concludes:

Treatment with HT in post-menopausal women for either primary or secondary prevention of CVD events is not effective, and causes an increase in the risk of stroke, and venous thromboembolic events. HT should therefore only be considered for women seeking relief from menopausal symptoms. Short-term HT treatment should be at the lowest effective dose, and used with caution in women with predisposing risk factors for CVD events.

A rather different message!

Jim Thornton

*Hormone replacement therapy (HRT) changed to hormone therapy (HT) Jan 2016