Benefits and risks of hormonal replacement therapy

Abstract

Menopause, defined as the permanent cessation of menstruation resulting from the loss of the ovarian function, has gradually become a fundamental health concern. Menopause hormonal replacement therapies (HRT) were initially developed with the purpose to alleviate the estrogen deficiency induced symptoms. Currently, HRT is approved by the FDA (Food and Drug Association) for four indications: bothersome vasomotor symptoms (VMS); prevention of bone loss; hypoestrogenism caused by hypogonadism, castration, or premature ovarian failure and genitourinary symptoms. For patients younger than 60 years or within the first 10 years from menopause onset and without contraindications, the benefit-risk ratio should be favorable for treatment of VMS and for preventing bone loss and related fractures. For women who initiate HRT more than 10 / 20 years from menopause onset (or aged 60 years or older), the benefit-risk balance seems to be less favorable than for younger patients because of greater absolute risks of cardiovascular disease, stroke and VTE. Even though the management of menopausal symptoms through pharmacological and cognitive-behavioral therapy improves quality of life of affected women in the short term, there is a need for the development of strategies to modify menopausal health risks, in the long term.