Long-term menopausal hormone therapy and health consequences – how to choose sides?

There is no debate any more on the good safety profile of postmenopausal hormone therapy (HT) in healthy perimenopausal and early postmenopausal women, but there are still many open issues related to the consequences of long-term HT, especially in older women. A recent Cochrane meta-analysis showed that women who started HT less than 10 years after the menopause had lower mortality and coronary heart disease (CHD), but more venous thromboembolism (DVT). However, in those who started treatment more than 10 years after the menopause, there was high-quality evidence that it had little effect on death or CHD between HT and placebo groups but there was an increased risk of stroke and DVT. In contrast, many large, observational studies such as a recent one from Finland (3.3 million years of HT exposure) have shown that the risk of CHD or stroke death and all-cause mortality was significantly reduced, both in those who initiated HT below or above age 60 years. Because of conflicting data concerning long-term HT use, it seems that every health-care provider chooses as reference those studies that can support his/her individual views and therapeutic approach.