Last update:


Arch Hellen Med, 27(5), September-October 2010, 776-782


Hormone replacement therapy: An update

Department of Endocrinology, "Hippokrateion" General Hospital, Athens, Greece

Because of the discrepancies in opinions about the benefits and risks of hormone replacement therapy (HRT), recently the International Menopause Society formulated a consensus statement concerning HRT. For women experiencing menopause before the age of 45 years, HRT is recommended until at least the age of 50 years. HRT in women <60 years of age reduces the risk of coronary heart disease, but it may be harmful when administered to older women in whom the endothelium has already undergone the process of atherosclerosis. Combined estrogen and progesterone therapy may lead to a small increase in the risk for breast cancer, but the risk for breast cancer has been shown to be not increased, or increased only slightly after several years of treatment in women treated with estrogen only following hysterectomy. HRT increases the risk of stroke and thromboembolism, but this risk is very low among women aged <60 years. HRT remains the most effective treatment for the vasomotor symptoms of menopause, it has a beneficial effect on connective tissue, skin, joints and intervertebral discs, and in some cases on the quality of life and sexuality. HRT reduces the risk of colorectal cancer and the incidence of all fractures (related to osteoporosis). HRT improves insulin resistance, reduces the risk of type 2 diabetes mellitus and has a positive effect on lipid levels and the metabolic syndrome. HRT lowers mortality by approximately 30% when administered to women aged <60 years, possibly due to protection from coronary heart disease. According to current recommendations, when indicated, and when administered within a few years after menopause, HRT is associated with more benefits than risks. The decision to treat a woman with HRT should be individualized and women on HRT should have regular follow up.

Key words: Breast cancer, Coronary heart disease, Hormone replacement therapy, Stroke, Venous thromboembolism.

© Archives of Hellenic Medicine