[Postmenopausal hormone substitution--for many or for a few? II. Relevant indications for long-term hormone...

In a theoretical model, women on long-term HRT will experience 28 per cent reduction in morbidity and a 1-2-year increase in life expectancy. The costs incurred by HRT are comparable with other preventive medication regimens. However, the decision to recommend or use HRT depends not only on the above-mentioned beneficial effects, but also on issues that defy objective assessment: the validity of observational studies; changes in quality of life among HRT users; and the medicalisation of postmenopausal women. Since attempts to resolve such issues are strongly coloured by personal opinions, it has been difficult to reach a consensus as to who should or should not use HRT. It is proposed that systematic evaluation of the six factors outlined in the article would simplify decision by the individual physician or patient as to the appropriateness of HRT.