[Present position of the hormonal replacement therapy]

Hormone replacement therapy (HRT) is not a homogenous group of pharmacological agents. The dose and the way of application can influence the different effects of pure estrogens, combination of estrogens and gestagens and selective tissue estrogenic activity regulators (STEARs). This should be taken into account when results of clinical trials are applied in practice. Conclusions from observational studies demonstrated a positive effect of HRT in both the primary and secondary prevention of ischaemic heart disease. But all randomised trials (HERS, HERS II, WHI, PHOREA, PHASE, WAVE) failed to prove this positive effect; on the contrary, the cardiovascular risk was increased in the beginning of therapy. The ongoing arm of WHI with estrogens only and the EPAT trial indicate possible positive effects of some HRT regimens. There are no new contraindications to HRT after the new results of clinical trials were published. The new results only underline the necessity of clear indication to HRT and confirm already well known risks: increased incidence of breast cancer with long-term use of HRT, increased risk of tromboembolic disease and stroke. The prevention of ischaemic heart disease was excluded from the possible indications of HRT. Many questions regarding optimal choice in the individual treatment strategies have been raised. HRT in its individualised form remains the first choice therapy for the acute climacteric syndrome, for the prevention and the therapy of urogenital atrophy. HRT is highly effective way of the prevention of osteoporosis and as such can be considered as the second line choice if the calcium and vitamin D represent the first line. Other beneficial long-term effects of HRT cannot be considered as the indication but as a possible positive of the individually long usage.