Postmenopausal Hormone Replacement Therapy

Abstract

PPROXIMATELY 38% OF POSTmenopausal women in the United States in 1995 used h o r m o n e r e p l a c e m e n t therapy (HRT), estrogen with or without progestin, to treat symptoms of menopause and prevent chronic conditions such as cardiovascular disease and osteoporosis. 1 Although treatment of symptoms of menopause, such as hot flashes and urogenital atrophy, among others, is a common indication for short-term use, potential preventive effects of HRT on long-term health outcomes have become an increasingly important consideration.In 1996, the second US Preventive Services Task Force (USPSTF) determined that there was insufficient evidence to recommend for or against HRT for all women but thought that individual decisions should be based on patient risk factors, an understanding of the probable benefits and harms, and personal preferences. 2 Many studies have been published since these recommendations were released, including the first report from the Women's Health Initiative (WHI), 3 a large randomized primary prevention trial, and the Heart and Estrogen/ progestin Replacement Study (HERS), 4 a secondary prevention trial reporting multiple outcomes. [4][5][6] This review was initiated to aid the current USPSTF in making new recommendations that will be Author Affiliations and Financial Disclosures are listed at the end of this article.

Reduction in hormone replacement therapy use and declining breast cancer incidence in the Belgian province of Limburg

“…Firstly, women who take HRT have access to health care, thus have a greater likelihood of being treated for co-morbidity or being motivated to undergo mammographic screening [27]. However, in the province of Limburg, the reduction in HRT use was not followed by a decrease in mammographic screening, in contrary the screening rose in that period.…”

Hormone replacement therapy and risks of oesophageal and gastric adenocarcinomas

“…The relation between HRT and gastric adenocarcinoma warrants further research before any clinical implications would be appropriate, particularly given the initial enthusiasm about the seemingly protective effect of HRT against cardiovascular disease, which was later not supported (Nelson et al, 2002).…”

Méthodologie de l’enquête MISSION (Ménopause, rISque de cancer du SeIn, mOrbidité et prévaleNce)

“…[10]. Le choix de cette réfé-rence a été motivé par la nature de cette publication : scientific review et par l'absence de données propres à la situation française.…”