Controversial guidelines published today could see a big increase in the prescribing of hormone replacement therapy for the menopause.
The National Institute for Health and Care Excellence says a million women could benefit from its guidance, aimed at improving care during the menopause.
The guidance says doctors can offer women HRT for hot flushes and night sweats after discussing the risks and benefits.
The treatment can also be considered for treating mild depression linked to the menopause, it says.
NICE claims it is relatively simple for doctors to explain to women the risks linked to HRT. It says that treatments based on oestrogen alone have little or no additional risk of breast cancer. Combined treatments involving oestrogen and progestogen are linked to increased breast cancer risk – but only while the patient is taking the hormone therapy, it says.
Its conclusions were challenged today by the senior researcher involved in identifying the risks of HRT.
Speaking to The Guardian, Professor Valerie Beral, from Oxford University, said: “About one million UK women are currently using hormones for the menopause.
“Among them, about 10,000 extra breast cancers are estimated to occur in the next ten years – 40,000 in total, instead of 30,000 if the women had not used the hormones.
"Also about 1,000 extra ovarian cancers are estimated to occur among them in the next ten years – 6,000 in total.”
But GP Dr Imogen Shaw, who helped develop the guidance, said: “Women should not feel they have to suffer in silence when menopause is affecting their daily lives at work and at home. The effects of menopause are often misunderstood and underestimated – it can impact on health significantly in both the long term and short term.
"Menopause also can result in problems including low mood, brittle bones, urogenital changes that can cause vaginal dryness and urinary tract infections, and it can affect a woman’s sex life.
“For the last decade, some GPs have been worried about prescribing HRT, and women worried about taking it. I hope that this new NICE guideline will empower women to talk to their GP or practice nurse about menopause and provide them with information on the range of options that could help. For health professionals, the guideline should boost their confidence in prescribing HRT, having fully discussed the woman’s individual circumstances with her.”
The guidance was also backed by two royal colleges.
Royal College of Obstetricians and Gynaecologists president Dr David Richmond described it as "a milestone."
Dr Heather Currie, chair of the British Menopause Society, said: "The menopause affects all women and can have significant consequences both on impact of symptoms and later health problems. Despite this, many women are unaware of the effects and are confused about benefits and risks of treatment options."
And Dr Helen Stokes-Lampard, of the Royal College of GPs, said: “There are very few effective alternatives to HRT. Low doses of modern antidepressants have been shown to help in some cases, but this involves prescribing these drugs off-licence, which has a number of medico-legal risks and the clarification that this should not be a first line approach to treatment is helpful to doctors.
“Many women are understandably concerned about the link that has been made between HRT and increased risk of breast cancer and other conditions, such as thromboembolism.
"But it is important to remember that these issues are closely related to prolonged use of HRT in older women and these risks reduce substantially after treatment is stopped."
Earlier this week, Professor Beral’s colleague at Oxford, Professor Klim McPherson told The Guardian that after HRT use dropped: "The breast cancer incidence went down noticeably. In whole populations.”
He claimed the original evidence on the subject had been "wound down" by a succession of critical articles, often in small medical journals.
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