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No wonder she was confused

In January 2004, a hysterectomy patient wrote this letter to The Lancet:

‘In 1986 I had a hysterectomy because of fibroids. The surgeon also removed my ovaries and found that I had endometriosis as well. Because I was then only 45 years old and would have had an immediate menopause, I was put onto hormone replacement therapy (HRT). The first year I took conjugated oestrogens (Premarin), but from 1988 until 2001 I had oestrogen implants every 6 months, given to me privately by the surgeon who did the operation. I was always a little dubious about having the treatment, since I felt I just did not have control over things once the implant was done, and also after several years had many headaches. Apart from that I felt very fit.

However, my surgeon assured me that HRT had so many advantages and that it suited me, which I agreed with. As time went on, HRT was reported to have more and more benefits and was not just the cosmetic drug it seemed to have been used for in its early years. It was now good for the heart, osteoporosis, and part defence against strokes. Every time I visited my surgeon, he seemed to have more evidence about the advantages of taking HRT. My surgeon retired in 2001 and I went to my National Health Service doctor. What a shock! He told me the exact opposite of my private surgeon – that it would be a good idea to come off HRT: it could increase the risk of heart disease, strokes, and breast cancer, and be the cause of headaches. I did have one more implant and then went onto Premarin for a short while, but since then I have not used HRT for about 8 months. My doctor said it would be my decision whether to stay on it or not. I was so confused . . . I cannot understand how HRT and all its wonderful advantages can be reversed in such a short space of time. How can a layman like myself come to a clear decision? I have spent many hours discussing and thinking about whether I should have stayed on HRT, although so far I have not suffered many ill effects. I am very confused about the whole issue and I am sure other women feel the same.’

Huntingford CA. Confusion over benefits of hormone replacement therapy. Lancet 2004;363:332.