Hormone replacement therapy increases the risk of ovarian cancer, a study shows.
The University of Oxford analysis showed there was an extra case for every 1,000 women taking the drugs for five years from the age of 50.
Lead researcher Sir Richard Peto said claims there was no risk for short courses of HRT "simply isn't true".
A leading cancer charity said this was a "modest increase on a relatively uncommon cancer."
Medical charities said the findings were robust, but said the risk did fall after HRT stopped.
HRT drugs are used to alleviate the symptoms of the menopause, which can be so severe they interfere with day-to-day life.
- Women have a one in 50 chance of developing ovarian cancer in their lifetime
- Taking HRT for five years is linked to one extra case of ovarian cancer per 1,000 women
- That takes the expected incidence from 20 women in 1,000 to 21 per 1,000
- One million women in the UK are on HRT
- There are 7,000 cases of ovarian cancer in the UK each year
In the UK, women take HRT mostly for between two and five years.
There is an increased risk of breast cancer, which has been well documented. However the drugs have also been found to reduce the risk of osteoporosis and bowel cancers.
But the impact on ovarian cancer has been debated, particularly for those taking the drug for less than five years.
The study in the Lancet, which looked at data from 52 separate studies including 21,500 women with ovarian cancer, proves there is a link.
Prof Sir Richard Peto said: "It's a risk, about a million women in this country have HRT and 1,000 will get ovarian cancer from it."
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Liz Arram: "It's important women don't go on a guilt trip about taking HRT"
He specified there would be one extra death for every 1,700 people taking hormone replacement therapy.
He said the risks would be reduced for those taking it for a shorter period of time but were still there.
He told the BBC News website: "If it were me and I had really bad symptoms, I'd worry more about those than any possible risk.
"But [these findings] should edge towards less use rather than more use."
SymptomsOvarian cancer is often difficult to diagnose as the symptoms are similar to irritable bowel syndrome and other conditions.
The main symptoms include:
- increased abdominal size and persistent bloating (not bloating that comes and goes)
- persistent pelvic and abdominal pain
- difficulty eating and feeling full quickly, or feeling nauseous
Source: NHS Choices
Commenting on the findings, Prof Montserrat Garcia-Closas, from the Institute of Cancer Research in London, told the BBC: "There's been a question for a long time about how solid the evidence was and this paper shows really very convincingly that there is an association."
But she cautioned: "It's a modest increase on a relatively uncommon cancer.
"For the general impact on a woman of average risk, then breast cancer will be a more important consideration than ovarian cancer."
Liz Arram from London - who took HRT and developed ovarian cancer - told BBC Radio 4's Today programme: "If I had looked at those risks at the time I was making the initial decision, I probably would not have chosen to do it."
Katherine Taylor, from the charity Ovarian Cancer Action, said: "Every woman is different though, and may each have different risk factors."
She said some women would be at increased risk because of their family history and the inheritance of some cancer risk genes, such as BRCA.
"Knowing her BRCA status could affect a woman's decisions around her health care. It could help her to decide whether HRT is the right path, for example."
The UK's medicine's regulator said it advised using the lowest does for the shortest possible time.
Do you take HRT or are thinking about taking HRT? Do you have concerns about the possible risks of using the drugs? You can email haveyoursay@bbc.co.uk with your experiences.
Please include a telephone number if you are happy to be contacted by a BBC journalist.
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