Introduction

Menopause symptoms are often debilitating, affecting personal, social and professional quality of life. The majority of women use hormone replacement therapy (HRT) for valid reasons having carefully weighed up the pros and cons. Young women with premature menopause also require HRT for the primary prevention of osteoporosis, cardiovascular disease and dementia. Following the findings of three studies, the Collaborative Reanalysis (CR),1 the Women's Health Initiative (WHI),2 and the Million Women Study (MWS),3 it has been claimed that HRT is an established cause of breast cancer. As a result of this, and despite the many accepted benefits of HRT, a significant proportion of women who could benefit from HRT are not using it.

The WHI and MWS had a profound effect on the prescribing of HRT and therefore on the lives of millions of menopausal women. Prescribing declined by more than two-thirds in most countries, including the UK, particularly by primary health care professionals who qualified in the last decade. Women were left feeling confused and at times terrified by alarmist headlines. This was illustrated by a survey through the Menopause Matters website where 70% of women who came off their HRT were aged less than 50 years and given current knowledge, 45% would not have discontinued therapy.4 A series of critiques of these studies (Parts 1–4)5–8 have been published in previous issues of this Journal. The latest paper in this series (Part 5)9 examines the reported decline in the incidence of breast cancer and possible attribution to the fall in …