Hormone replacement therapy: dilemmas in 2002

About 6 million women in the United States are prescribed a combined estrogen-progestin regimen during and after the menopause. The immediate benefits of hormone replacement therapy (HRT) are relief of menopausal symptoms. Doctors and their patients have long presumed that the benefits on cardiovascular disease and osteoporosis outweigh the possible increased risk of breast cancer or venous thrombosis. The Women's Health Initiative, a National Institutes of Health program, is the first study to compare HRT to placebo in healthy women. The July 2002 report of increased cardiovascular events as well as increased breast cancer diagnosis in women on the HRT arm of the study brought widespread media coverage and has led to distress and confusion among women taking HRT. Women with a personal or family history of breast cancer pose a particular challenge to their physicians when they ask for advice about HRT.