[Present position of the hormonal replacement therapy]

Area of Science:

• Pharmacology and Endocrinology
• Cardiovascular Medicine
• Women's Health

Context:

• Hormone replacement therapy (HRT) encompasses diverse agents (estrogens, progestogens, STEARs) with varied effects based on dose and administration.
• Clinical trial results necessitate careful application in practice, considering the heterogeneity of HRT formulations.
• Previous observational studies suggested HRT benefits for ischemic heart disease, contrasting with later randomized trial findings.

Purpose:

• To analyze the evolving understanding of hormone replacement therapy (HRT) based on recent clinical trial data.
• To clarify the indications and contraindications for HRT, particularly concerning cardiovascular health and osteoporosis.
• To address the complexities of individualized HRT treatment strategies.

Summary:

• Randomized trials (e.g., WHI, HERS) did not confirm HRT's benefit for ischemic heart disease prevention and indicated potential increased cardiovascular risk initially.
• Ongoing trials and specific estrogen-only regimens may show positive cardiovascular effects, warranting further investigation.
• HRT is confirmed as a primary treatment for acute climacteric syndrome and urogenital atrophy, and a second-line option for osteoporosis prevention.

Impact:

• Ischemic heart disease prevention is no longer a valid indication for HRT.
• Established risks of HRT include increased breast cancer incidence with long-term use, thromboembolic disease, and stroke.
• Individualized HRT remains crucial for managing menopausal symptoms and preventing osteoporosis, with other benefits considered secondary.