Managed care of hormone replacement therapy in the menopause

The principles of managed care are more difficult to apply to preventive medical treatments, such as hormone replacement therapy, than to the investigation and treatment of established disease. In addition to an ageing society with increased health demands, the use of hormone replacement therapy is increasing in most developed countries. Clinical guidelines for the counselling of post-menopausal women and the use of hormone replacement therapy have been prepared by the American College of Physicians. There is limited information about the benefits and risks of hormone replacement therapy from randomized prospective studies and these guidelines are based on the best available data from observational studies and meta-analysis. More secure data will become available within the next decade from long-term studies that are currently in progress. Managed care proposals for hormone replacement therapy must be flexible enough to adjust to new data as they become available while recognizing that, given current knowledge, hormone replacement is healthcare-cost-effective for the vast majority of menopausal women.