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What's wrong with hrt research?

MagazineJune 2002 (Vol. 13 Issue 3)What's wrong with hrt research?

How can it be that recent studies are so at odds with previous ones? The early research into HRT is beset by a number of problems, including:

How can it be that recent studies are so at odds with previous ones? The early research into HRT is beset by a number of problems, including:


* a lack of control groups, making it difficult to see the effects of HRT compared with non-users


* selection of healthy women. The women in HRT trials are usually of a higher socioeconomic status. They also tend to be more physically active, to have a more stable blood pressure and are leaner than the average 'real-world' user. This results in the so-called 'healthy-user' effect, where such users are less vulnerable to the adverse effects of HRT


* short-term trials. Women were followed for arbitrary amounts of time, providing no data on the long-term risks and death rates


* no placebo for comparison. A placebo can cure 30 to 90 per cent of problems. If HRT can't beat a placebo, it's probably not much good


* poor reporting of adverse effects. Often, women who suffer adverse side-effects are taken out of a trial early. Other adverse effects deemed to be not directly related to the primary outcome being looked at tend to be dismissed as unimportant


* different definitions of HRT. In early trials, 'HRT' was any kind of hormone supplement given at any dose and in a variety of forms. We now know the route of entry into the body and the dosages can significantly affect the outcome.


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