The New Hrt Study Will Empower Women

Teresa Gorman is pretty tough, but she seems to see most other women as nervous kittens. The former Tory MP says that a new study showing a greatly increased risk of breast cancer for women who use hormone replacement therapy (HRT) would "frighten women unnecessarily".

HRT has always benefited from supporters who preferred reassuring ideals to realities. From the start, an absurdly dreamy language was used to sell the possibilities of this wonder drug. One doctor, Robert Greenblatt, declared 40 years ago: "Women will be emancipated only when the shackles of hormone deprivation are loosed." Another, Robert Wilson, said it would give women "age-defying youthfulness... a straight-backed posture, supple breast contours and that particular vigour and grace... "

But reality kept intruding. For a start, there were some women who didn't want to be emancipated from their ageing bodies. And more tricky for the image of HRT was the testimony from women who did want such freedom, but found that HRT didn't supply it. After the promises made by some doctors, many women were immediately disappointed by side-effects such as nausea or bleeding, or HRT's ineffectiveness at tackling their symptoms.

Other people were disappointed more gradually. Although this particular study of increased risks of breast cancer is the most compelling so far, for many years other studies have been whispering similar results that cast doubt on the magic medicine. A large research project into the safety of one kind of HRT, Prempro, was cancelled last year, after early evidence showed that women taking it were facing unacceptable risks of breast and uterine cancer. Three years ago a study at the University of California suggested that HRT tripled the risk of blood clots. Six years ago four British doctors signed a letter in the BMJ asking dolefully if it was still "ethical" for doctors to go on prescribing hormone replacement therapies.

Yet few people - least of all the drug companies who market the 40 different HRTs available in the UK, from pessaries to tablets to implants to patches - wanted to frighten women unnecessarily. Professor Chris van Weel, author of a commentary published in the Lancet alongside yesterday's study, is scathing about the drug companies' behaviour over recent years. "We must deplore their over-enthusiastic promotion," he told me.

HRT is not the only broken promise that this generation of women feel they have had from doctors and drug companies. Over the last 50 years medicine has built many castles in the air that on closer inspection turned out to stand on shaky foundations. Many women bought the dream of risk-free contraception for life with the pill, and then learned slowly over the years about side-effects ranging from the trivial to the more serious, such as an increased risk of thrombosis. Some women believed over-enthusiastic fertility specialists who promised that they could give every woman a baby, only to find that they were left out of pocket, with an empty cradle.

That doesn't mean that women have simply been the victims of a meddling medical profession and that we should fight back. Most women don't see ourselves as victims of doctors. Most of us do want to be able to lay down the most onerous burdens our bodies might give us - from heavy menstruation to unplanned pregnancy to painful childbirth to infertility to miserable menopause - and we are quite well aware that the medical establishment has helped us do so in to an extent that women in other times and places would desperately envy.

But even if ordinary women are not just victims, neither do we have the power and knowledge that we would like to resist the more absurd promises of drug companies and idealistic doctors. Studies such as this one help to empower us. They will not just send women away, cowering. Indeed, as this latest disappointment shakes down, we will find that the days of HRT are not over yet. Even with this new evidence, many experts still believe that in some circumstances benefits can outweigh risks; so do many women. Newspapers yesterday were full of articulate, definite women who had used HRT - some of whom had even had breast cancer - and had no regrets. Those women who are having a miserable menopause, and find that HRT does work to relieve their symptoms, may go on, quite rightly, trading the possibility of a nearer death for the certainty of a better life.

Women and their doctors will never be sure of making perfect decisions, however many statistics we have to empower us. There is no perfection, since even the best statistics must founder on the particular, elusive reality of a single life. But at least we can try to make such judgments with as much understanding of the facts as we can muster, even - or especially - the most frightening ones.