Hormones and menopause: pro

Since the publication of the first controlled randomised trials with disease event outcomes, it has become fashionable to denigrate hormone replacement therapy (HRT). The lack of protection against cardiovascular disease and the moderate increase of the risk of developing breast cancer and other ailments were given wide publicity by the lay press, which caused a considerable anxiety among users. The fact that a similar or even greater increase in the risk of developing a breast carcinoma is associated with a menarche before the age of 11 years, nulliparity, a first pregnancy after the age of 35 years, obesity, and moderate alcohol consumption was not mentioned. As a consequence, the adverse effects were put out of perspective and public opinion--including the medical profession--was blatantly misled. The reporting by medical journals was frequently equally biased. In the light of available evidence one can objectively state that HRT tailored to the needs of the individual woman and started around or shortly after the menopause improves her quality of life at the cost of a negligible risk. Oestrogens are ideally administered parenterally. In women who did not undergo a previous hysterectomy, the progestin should be delivered in the uterine cavity rather than systemically, which might lead to a lesser risk of breast malignancy. Indeed, this latter is not or not significantly increased when unopposed oestrogens are administered. Likewise, the risks of cardiovascular disease and stroke are not increased in treated women, aged 50-59 years. In older women, HRT initiated in the perimenopause can be continued using lower doses.