Indications for hormone therapy: the post-Women's Health Initiative era

Information from the Women's Health Initiative (WHI) trial has given physicians valuable tools for counseling women aged 50 to 79 years about the short-term risks of hormone therapy (HT). Unanswered questions remain, particularly on the risks and benefits of discontinuing HT among long-term users. The decision to discontinue HT should be carefully considered, because stopping and re-starting after several months may "reset the clock" for risks associated with changes in hepatic protein synthesis. The current authors recommend low-dose transdermal hormonal formulations,but no large-scale randomized trials exist to confirm the veracity of this recommendation. It has been suggested that starting HT in the menopausal transition would alleviate the HT risks observed withWHI. Until additional data are available to counsel women in the menopausal transition, however, the conservative counseling approach is to apply those figures available from the WHI, particularly because women aged 50 to 59 years using estrogen-progestin therapy have an unfavorable risk-benefit ratio, similar to that seen in older women.