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Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) is an effective treatment for menopausal symptoms. For many years, clinicians used systemic HRT to treat women in menopause, believing that HRT could benefit cardiovascular health, prevent osteoporosis, and help women live longer and healthier lives. In 2002, however, the Women’s Health Initiative (WHI) changed this practice. The trial was stopped early because the results showed that the risks of hormone replacement with estrogen and progesterone in women with a uterus outweighed the potential health benefits. Subsequent research has further clarified the risks associated with HRT, as critics felt that the results of the WHI trial could not be generalized because the participants were older (primarily 60s and 70s) and used only oral preparations of estrogen and progesterone.
The following information summarizes the benefits and risks for women using HRT for menopausal symptoms. Ultimately, HRT is an individual decision that must be made by a patient, considering her specific situation and health history, in consultation with her provider.
Benefits of Hormone Replacement Therapy
Hormone replacement therapy is the most effective treatment for the vasomotor and vaginal symptoms associated with menopause. 1 Research shows that estrogen-only therapy decreases coronary heart disease and reduces risk of breast cancer in women younger than 60 years when started within 10 years of menopause onset. Both estrogen-only and estrogen plus progesterone therapy decrease the risk of hip fracture.2,3
Risks of Hormone Replacement Therapy
The risks of HRT vary with the type, dose, route of administration, duration of use, and age of initiation. Results from the WHI, with treatment consisting of oral estrogen and medroxyprogesterone acetate, demonstrated an increased risk of invasive breast cancer and cardiovascular events including heart attacks, cerebrovascular events, and blood clots.4. Further analysis and research has shown that oral HRT (both estrogen-only and combined estrogen and progesterone) increases the risk of thromboembolic events, with risk of stroke increasing with age and with initiation of therapy >10 years from onset of menopause. Estrogen plus progesterone therapy is associated with a small increased risk of breast cancer, which is greater with use of synthetic progestins (ie, medroxyprogesterone acetate). HRT is also associated with an increased risk of gallbladder disease, although overall risk is low.2,5,6