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Hormone replacement therapy in postmenopausal women.

Edgar D Staren1, Shuab Omer

  • 1Department of Surgery, Medical College of Ohio, 3065 Arlington Ave., Toledo, OH 43614-5807, USA. estaren@mco.edu

American Journal of Surgery
|July 14, 2004
PubMed
Summary

Hormone replacement therapy (HRT) was once thought to protect against heart disease but now appears to increase risks. Current data suggest HRT risks outweigh benefits for postmenopausal women.

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Area of Science:

  • Cardiovascular Science
  • Endocrinology
  • Women's Health

Background:

  • Hormone replacement therapy (HRT) was historically viewed as protective against coronary artery disease (CAD) in postmenopausal women.
  • This perception was supported by observational studies and basic science research.
  • The presumed cardiovascular benefits were a key rationale for HRT use.

Purpose of the Study:

  • To evaluate the current scientific data on the benefits and risks of HRT.
  • To reassess the role of HRT in the prevention of chronic diseases.
  • To provide updated clinical recommendations for HRT use in postmenopausal women.

Main Methods:

  • Review of recent randomized controlled trials (RCTs) on HRT.
  • Analysis of data on cardiovascular outcomes, cancer incidence, and other health risks associated with HRT.

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  • Synthesis of evidence regarding HRT's impact on bone mineral density and fracture risk.

    • Main Results:

    • Recent RCTs challenge the protective role of HRT against CAD, indicating a potential increase in risk.
    • HRT is associated with increased risks of breast cancer, stroke, venous thromboembolism, and cholecystitis.
    • While HRT offers benefits like increased bone mineral density and reduced fracture and colorectal cancer risk, these are outweighed by the adverse effects.

    Conclusions:

    • HRT is no longer routinely recommended for the prevention of chronic diseases.
    • The risks associated with HRT, including cardiovascular events and cancer, outweigh its benefits for most postmenopausal women.
    • Clinical recommendations emphasize a careful assessment of individual risks and benefits before considering HRT.