Authors' objectives:

This report aims to assess the effectiveness of postmenopausal hormone replacement therapy (HRT).

Authors' recommendations: Hormone replacement therapy is a reasonable choice for women with severe menopausal symptoms. There are potentially three reasons for initiating hormone replacement therapy. They are: 1) to reduce the physical symptoms associated with menopause such as hot flashes and vaginal dryness; 2) treat psychological symptoms such as sleeplessness and mood swings; and 3) to reduce the risk of osteoporosis. Estrogen prevents the accelerated loss of bone associated with menopause, maintains bone density, and reduces the risk of hip fracture. The risk of vertebral fractures may be decreased by as much as 90%, depending upon when HRT is initiated. There are several potential side effects that can occur with HRT in varying frequencies. These side effects include bleeding, weight gain, breast tenderness, headaches, mood swings and skin irritation. Most side effects of HRT can be improved or corrected by making changes in the replacement treatment and/or dosage. As many as two-thirds of women who start HRT stop within 2 years. One main reason they stop is because of side effects, particularly the irregular menstrual bleeding. Many studies have demonstrated that the long-term use of estrogen alone increases the risk of cancer in the uterus. Addition of a sufficient dose of a progestin, which opposes the effects of estrogen on the endometrium, eliminates these risks and should be an integral part of postmenopausal hormone-replacement therapy for a woman with an intact uterus. Studies have shown that postmenopausal use of estrogen increases the risk of deep venous thromboembolism (formation of blood clots within blood vessels). Recent report suggests that there is a significant venous thrombosis amongst women on HRT compared with women on placebo. Recently, it has been reported that there is no overall cardiovascular benefit. Some studies indicate a pattern of early increase in risk of coronary heart disease events. Therefore, HRT for the purpose of secondary prevention of coronary heart disease is not recommended.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.health.state.mn.us/htac/hormone.htm

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Health Technology Advisory Committee

Contact Address: Queries should be referred to the Minnesota Department of Health (http://www.health.state.mn.us/)

Copyright: Health Technology Advisory Committee