Hormone replacement therapy: discrepancies between evidence and recommendations.

Area of Science:

• Endocrinology
• Pharmacology
• Preventive Medicine

Background:

• Postmenopausal hormone therapy (PHT) is a common intervention for disease prevention in women.
• Current evidence supporting PHT relies heavily on intermediate outcomes and non-experimental studies, not definitive clinical trial data.
• The long-standing use of PHT contrasts with the limited understanding of its true efficacy and safety profile.

Discussion:

• The evidence base for PHT is insufficient for its widespread preventive use.
• There's a critical need to differentiate between surrogate markers and actual clinical benefits.
• The influence of pharmaceutical companies on research and dissemination of findings requires scrutiny.

Key Insights:

• Robust randomized controlled trials (RCTs) are essential to establish the true preventive value of PHT.
• Existing data from intermediary outcomes and observational studies may not accurately reflect clinical outcomes.
• Addressing potential bias in research is crucial for objective evaluation of PHT.

Outlook:

• Future research should prioritize large-scale, long-term RCTs for PHT.
• Greater transparency in clinical trial reporting and funding is necessary.
• A critical re-evaluation of PHT guidelines based on high-quality evidence is warranted.