The safety of unopposed low potency oestrogens, prescribed to treat urogenital symptoms in post menopausal women, is once again being questioned in new evidence which shows a link between HRT and endometrial cancer.

A recent collaborative study between US and Scandinavian researchers looked at women who developed endometrial cancer in Sweden during 1994-95.

Age matched controls were randomly selected from population registers. The researchers looked at both oral (oestriol 1-2 mg daily) and vaginal (dienoestrol, oestradiol and oestriol) preparations. Past use of oral contraceptives was also taken into account.

Endometrial cancer was up to three times more common in those who used the oral preparation for five or more years. The incidence of endometrial abnormalities was up to eight times higher in long term users.

Users of vaginal preparations fared better with long term users at an only slightly elevated risk of developing cancer (Lancet, 1999; 353: 1824-8).

l What is the risk of stroke for women taking the Pill, and has that risk altered between second generation pills (levonorgestrel) and newer third generation (desogestrel or gestodene) pills? This is what a small US study set out to find (Lancet, 1999; 354: 302-3).

The answer is there is no difference. The retrospective study looked at the medical records of 430 medical practices and identified those women who had taken second or third generation pills and who had suffered stroke.

No matter what pill the women took, and even if she was a past user, her risk was still 1.5 to 2.3 times greater than non users.