Hormone Replacement Therapy (HRT) has received consistently bad press, despite re-analysis of previous data new studies and supporting Consensus Statements from leading national and international societies. Many women have been convinced by women's journals and the media not to even consider HRT as an option and, General Practitioners, still limit duration to 5 years or, will, arbitrarily, discontinue prescriptions in the early 50s. This article seeks to make sense of our current position. Previous and new evidence on the safety of HRT is reviewed. New data on the long-term consequences of non-treatment of women with Premature Ovarian Insufficiency (POI) is presented and the dichotomy of the older female workforce is explored. From this, a logical plan of management emerges.
PanayNHamodaHAryaR. The 2013 British Menopause Society & Women’s Health Concern recommendations on hormone replacement therapy. Menopause Int2013; 19: 59–68.
3.
RCOG 47th Study GroupMenopause and hormone replacement. In: CritchleyHGebbieABeralV (eds). Consensus views arising from 47th Study Group: Menopause & Hormone Replacement, London, UK: RCOG Press, 2004, pp. 345–345.
4.
SturdeeDWPinesAInternational Menopause Society Writing Group. Updated IMS recommendations on postmenopausal hormone therapy and preventive strategies for midlife health. Climacteric2011; 14: 302–320.
5.
SantenRJAllredDCArdoinSP. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab2010; 95: s1–s66.
6.
BowringCEFrancisRM. National Osteoporosis Society’s position statement on hormone replacement therapy in the prevention and treatment of osteoporosis. Menopause Int2011; 17: 63–65.
7.
MansonJEHsiaJJohnsonKC. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med2003; 349: 523–534.
8.
AndersonGLLimacherMAssafAR. Effects of conjugated equine estrogen in post-menopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA2004; 291: 1701–1712.
9.
Wassertheil-SmollerSHendrixSLLimacherM. Effect of estrogen plus progestin on stroke in postmenopausal women: the Women’s Health Initiative: a randomized trial. JAMA2003; 289: 2673–2684.
10.
ViscoliCMBrassLMKernanWN. A clinical trial of estrogen-replacement therapy after ischemic stroke. N Engl J Med2001; 345: 1243–1249.
11.
CherryNGilmourKHannafordP. Oestrogen therapy for prevention of reinfarction in post-menopausal women: a randomised placebo controlled trial. Lancet2002; 360: 2001–2008.
12.
HulleySGradyDBushT. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA1998; 280: 605–613.
13.
HøibraatenEQvigstadEArnesenH. Increased risk of recurrent venous thromboembolism during hormone replacement therapy-results of the randomized, double-blind, placebo-controlled estrogen in venous thromboembolism trial (EVTET). Thromb Haemost2000; 84: 961–967.
14.
ClarkeSCKelleherJLloyd-JonesH. A study of hormone replacement therapy in postmenopausal women with ischaemic heart disease: the Papworth HRT atherosclerosis study. BJOG2002; 109: 1056–1062.
15.
WatersDDAldermanELHsiaJ. Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial. JAMA2002; 288: 2432–2440.
16.
ChlebowskiRTHendrixSLLangerRD. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative Randomized Trial. JAMA2003; 289: 3243–3253.
17.
StefanickMLAndersonGLMargolisKL. Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. JAMA2006; 295: 1647–1657.
18.
ShapiroSFarmerRDSeamanH. Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies: Part 1. The Collaborative Reanalysis. J Fam Plann Reprod Health Care2011; 37: 103–109.
19.
ShapiroSFarmerRDMueckAO. Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies: Part 2. The Women’s Health Initiative: estrogen plus progestogen. J Fam Plann Reprod Health Care2011; 37: 165–172.
20.
ShapiroSFarmerRDMueckAO. Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies: part 3. The Women’s Health Initiative: unopposed oestrogen. J Fam Plann Reprod Health Care2011; 37: 225–230.
21.
ShapiroSFarmerRDStevensonJC. Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies. Part 4: the Million Women Study. J Fam Plann Reprod Health Care2012; 38: 102–109.
22.
SchierbeckLLRejnmarkLToftengCL. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ2012; 345: e6409–e6409.
23.
PaiJKMansonJE. Acceleration of cardiovascular risk during the late menopausal transition Menopause. J North Am Menopause Soc2013; 20: 1–2.
24.
BlackDMBauerDCSchwartzAV. Continuing bisphosphonate treatment for osteoporosis-for whom and for how long?N Engl J Med2012; 366: 2051–2053.
25.
Islam R and Cartwright R. The impact of premature ovarian failure on quality of life: results from the UK 1958 Birth Cohort, 27th Annual Meeting of the European–Society-of-Human-Reproduction-and-Embryology. Oxford Univ Press, 2011, p. I108–I108.
26.
WellonsMOuyangPSchreinerPJ. Early menopause predicts future coronary heart disease and stroke: the Multi-Ethnic Study of Atherosclerosis. Menopause2012; 19: 1081–1087.
27.
RoccaWAGrossardtBRMillerVM. Premature menopause or early menopause and risk of ischemic stroke. Menopause2012; 19: 272–277.
28.
ShusterLTRhodesDJGostoutBS. Premature menopause or early menopause: long-term health consequences. Maturitas2010; 65: 161–166.
29.
Source: Age UK Tavis House 1-6 Tavistock Square London WC1H 9NA Published on 20 June 2011 05:00 PM Age UK statement on increase to women’s state pension age.
JirapinyoMTheppisaiUManonaiJ. Effect of combined oral estrogen/progestogen preparation (Kliogest) on bone mineraldensity, plasma lipids and postmenopausal symptoms in HRT-naïve Thai women. Acta Obstet Gynecol Scand2003; 82: 857–866.
32.
ZhouYZSunLZLinJF. [Evaluation the efficacy and safety of estradiol and drospirenone tablets in the treatment of menopausal symptoms among postmenopausal Chinese healthy women: a randomized, multi-center, double-blind, placebo-controlled clinical study]. Zhonghua Fu Chan Ke Za Zhi2011; 46: 345–349.
33.
GräserTRömerTWiedeyKD. Climodien (estradiol valerate 2 mg plus dienogest 2 mg) is safe and effective in the treatment of postmenopausal complaints. Climacteric2001; 4: 332–342.
34.
Heikkinen J, Vaheri R and Timonen U. Long-term safety and tolerability of continuous-combined hormone therapy in postmenopausal women: results from a seven-year randomised comparison of low and standard doses. J Br Menopause Soc 2004; 10: 95–102. Erratum in: J Br Menopause Soc 2004; 10: 168.
35.
CanonicoMPlu-BureauGLoweGD. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ2008; 336: 1227–1231.
36.
OliéVPlu-BureauGConardJ. Hormone therapy and recurrence of venous thromboembolism among postmenopausal women. Menopause2011; 18: 488–493.
37.
CummingsSREttingerBDelmasPD. The effects of tibolone in older postmenopausal women. N Engl J Med2008; 359: 697–708.
38.
RenouxCDell'anielloSGarbeE. Transdermal and oral hormone replacement therapy and the risk of stroke: a nested case-control study. BMJ2010; 340: c2519–c2519.
