Postmenopausal hormone therapy in the aftermath of the WHI. What patients need to know

HT is now relegated primarily to the treatment of menopausal symptoms. It should be used for this indication at the lowest effective dose and for the shortest duration possible. Consideration should be given to other strategies to control symptoms when patients are willing to try less effective but potentially safer alternatives to HT. There is little support for the HT to prevent chronic conditions. The risks of combined HT appear to outweigh the benefits. However, the jury is still out regarding the use of estrogen alone. Ongoing research is likely to provide more informaton about the effects of HT on quality of life, cognition, and prevention of Alzheimer's disease. These potential benefits could tip the balance in favour or HT use for some patients. Any decision about starting or stopping HT requires a comprehensive discussion between the physician and the patient regarding benefits, risks, and uncertainties. The WHI results underscore the importance fo well-designed randomized controlled trials to inform our treatment discussions. Even the best observational studies have the portential to mislead us.