HORMONE REPLACEMENT THERAPY

The following Question stood in the name of Mdm Halimah Yacob -

Mdm Halimah Yacob: To ask the Minister for Health in view of a recent American report which cast serious doubts about the safety of Hormone Replacement Therapy (HRT), can his Ministry confirm whether (i) HRT is safe; (ii) there are studies done in Singapore to determine the impact of HRT on women and, if so, what are the findings; (iii) it has checked with the World Health Organisation on the safety of HRT; and (iv) there are HRT alternatives for women and are these made available at Government clinics and restructured hospitals.

Mr Arthur Fong (West Coast): Sir, Question No. 3.

The Minister of State for Health (Dr Balaji Sadasivan) (for the Minister for Health): Mr Speaker, Sir, Hormone Replacement Therapy (HRT) refers to the use of prescription drugs to "replace" the hormones that the ovaries stop making at the time of menopause. The short-term use of HRT to relieve menopausal symptoms and improve quality of life is established. This benefit is recognised by the World Health Organisation.

There had been past studies which suggested that long-term HRT use could reduce the risk of heart attacks and hip fractures due to osteoporosis. On the other hand, there had also been studies which associated long-term HRT use to breast and ovarian cancers and pulmonary embolism.

The Women's Health Initiative (WHI) study in the United States is the first randomised control trial, or the "gold standard" in studies on effectiveness, in the world to study the potential benefits of long-term HRT use. The study was terminated early as health risks exceeded health benefits. For every 10,000 women using combined HRT at the prescribed dosages in the study for one year, there would be seven more heart attacks, eight more breast cancers, eight more strokes and eight more pulmonary emboli compared to six fewer colorectal cancers and five fewer hip fractures.

There have been no randomised control trials on HRT done in Singapore. The Ministry of Health will appoint a specialist group to develop practice guidelines for doctors on HRT. Depending on the indications for HRT treatment, there are alternative treatments available at polyclinics and restructured hospitals. The Ministry of Health advises women on HRT to consult their doctors regarding their treatment.

Dr Lily Neo (Jalan Besar): Sir, may I ask the Minister of State whether it is correct to say that many HRT products contain different compounds in different dosages? Therefore, should the WHI result, mentioned earlier by the Minister of State, be applied to any other HRT products other than the one investigated in the trial? Am I correct to say that market research confirms that the relief of menopausal symptoms is the number one reason why women take HRT? But the effects of the HRT product on menopausal symptoms and the quality of life were not measured in the WHI trial. Should this not be included in any comprehensive trial?

Dr Balaji Sadasivan: Sir, Dr Neo is correct that there are quality of life issues involved in the use of HRT, and the long-term treatment of HRT should be individualised to the patient. That is why the Ministry of Health feels that individual patients must consult their doctor regarding the appropriateness of the treatment.