Hormone Replacement Therapy in menopause: current concerns and considerations.
It has been estimated that one third of postmenopausal women in the U.S. use Hormone Replacement Therapy (HRT) to treat symptoms of menopause and prevent chronic conditions. In developing countries HRT use is not so common but there is an increasing trend in its use. It has been seen that women with better socio-economic status, higher education and urban population use HRT. It is important that benefits and harms of HRT based on scientific evidence should be considered when prescribing HRT. The health care workers should prepare themselves for a better dialogue with women including information about alternative treatment.


OBJECTIVE
To review the available evidence on benefits and harms of HRT.


METHODS
A Medline search was done for papers published in English language between 1990 to 2003, with abstracts available. The limitations set were original articles and reviews. The key words used were Menopause, Hormone Replacement, HRT, and ERT. The local libraries were searched and email requests were sent for full text articles. 10 full text articles were available, mostly review and large studies, which were studied in more detail. Some textbooks and reference books for gynaecology were also reviewed.


RESULTS
Beneficial effects of HRT on vasomotor symptoms have been supported by various studies, but HRT to treat negative mood is not recommended. A systematic review of Cochran database showed little evidence regarding the effect of hormone replacement therapy or oestrogen replacement therapy on overall cognitive function in healthy postmenopausal women. Oestrogens and androgens have significant beneficial effects on skin collagen, but do not prevent the effect of aging on elastic tissue and have limited use in the prevention and treatment of skin changes of menopause. Short-term benefits have been shown for urogenital atrophy. Recent evidences suggest that benefits of HRT include prevention of osteoporotic fractures, and colorectal cancer while prevention of dementia is uncertain. Harms include Coronary Heart Disease (CHD), stroke, thromboembolic events, breast cancer, with 5 or more years of use, and cholecystitis. It is recommended that the regimen should not be initiated or continued for primary prevention of coronary heart disease. In women with CHD, it should not be used for secondary prevention of CHD events. Active living, alternative therapies and consumption of food rich in phyto-oestrogens are some areas, which need to be explored in more detail.


CONCLUSIONS
Patient preferences as well as evidence are important to initiate and/or continue HRT. Benefits and harms need to be re-addressed periodically to apply newly published evidence and to reassess emerging risk, co-morbidities and need of individuals.
Sharma
Sudha
S
D000368:Aged; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*