Another hormone replacement trial has been halted over fears of increased breast cancer risks. Women's Editor Christen Pears looks at the pros and cons of HRT.

A FEW years ago it was hailed as a wonder drug, an end to hot flushes and night sweats, a first line of defence against the brittle bone disease osteoporosis, but hormone replacement therapy may do more harm than good.

Earlier this week, a Swedish study of breast cancer survivors was brought to an end three years early after it was discovered that HRT could significantly increase the chances of cancer recurring.

Of the 174 women who were given HRT, 26 suffered a recurrence of breast cancer or a new tumour. That compared with only seven among the 171 taking non-hormonal treatments for menopausal symptoms.

Around 3,000 British women are taking part in a similar trial run by Cancer Research UK. The charity is now carrying out a review to decide whether it should continue.

Thousands of pre-menopausal women in the UK are diagnosed with breast cancer each year. Some will undergo an early menopause due to treatment, while others will develop menopausal symptoms naturally.

But while the authors of the Swedish study concluded that HRT posed an "unacceptable risk" to patients, other, unpublished research suggested there was no increased risk. So is it safe to take HRT if you have a history of breast cancer?

Dr Richard Sullivan, from Cancer Research UK, says the picture is now confused for both doctors and patients.

"The downside is that women who develop breast cancer early in their lives will be left wondering whether or not it is safe to take HRT - a question which is now unlikely ever to be definitively answered."

The Department of Health said that the general advice for women with a history of breast cancer was to avoid HRT. Drug manufacturers advise not giving HRT to anyone with a history of breast cancer, although doctors have the discretion to prescribe it, and some experts still recommend the treatment for women whose quality of life is blighted by severe menopausal symptoms.

Dr John Stevenson, of Women's Health Concern, says this practice should not be changed by the Swedish study, which was too short to be conclusive.

"It has been standard practice for many years in the UK to avoid giving HRT to women with active or previous breast cancer. However, there are occasional circumstances where HRT use is justified in such women. This would be particularly in women who were experiencing such severe menopausal symptoms as to cause a marked impairment of their quality of life. Such women would be counselled about the risks of HRT, but could then decide for themselves whether the risk was worth taking because of the severity of their symptoms."

During the menopause, levels of the sex hormone oestrogen decline, leading to a range of symptoms including night sweats, hot flushes, mood swings, fatigue, and an increased risk of osteoporosis.

Many women turn to HRT for relief, but even those without a history of breast cancer may be putting themselves at risk. The results of a massive study, published last year, confirmed a definite link with the disease.

As part of the Million Women Study, Cancer Research monitored one million women between the ages 50 and 64. In the case of combined oestrogen-progestogen HRT, the risk of developing breast cancer actually doubled. The dramatic findings, coupled with the latest research, have left thousands of women facing a dilemma over whether to stop taking the pills which help them overcome menopausal symptoms.

While many women will no doubt continue with the treatment, believing the benefits outweigh the risks, there are natural alternatives.

Regular load bearing exercise, such as walking and running, as well a calcium and vitamin D supplements, can help strengthen bones. Aching joints can be eased with glucosamine and fatty acids, found in oily fish, soya and leafy green vegetables, while a well-balanced diet helps the body adjust automatically to hormone changes. Herbal remedies can be beneficial for hot flushes and night sweats.

The advice from experts about HRT is not to panic. There are risks and benefits to be balanced. Women should talk to their GP and make sure they have all the facts before making a decision.

* For more information visit www.amarantmenopausetrust.org.uk or www.breastcancercare.org.uk