title: Back to the future: Hormone replacement therapy as part of a prevention strategy for women at the onset of menopause.
abstract: In the late 1980s, several observational studies and meta-analyses suggested that hormone replacement therapy (HRT) was beneficial for prevention of osteoporosis, coronary heart disease, dementia and decreased all-cause mortality. In 1992, the American College of Physicians recommended HRT for prevention of coronary disease. In the late 1990s and early 2000s, several randomized trials in older women suggested coronary harm and that the risks, including breast cancer, outweighed any benefit. HRT stopped being prescribed at that time, even for women who had severe symptoms of menopause. Subsequently, reanalyzes of the randomized trial data, using age stratification, as well as newer studies, and meta-analyses have been consistent in showing that younger women, 50-59 years or within 10 years of menopause, have decreased coronary disease and all-cause mortality; and did not have the perceived risks including breast cancer. These newer findings are consistent with the older observational data. It has also been reported that many women who abruptly stopped HRT had more risks, including more osteoporotic fractures. The current data confirm a "timing" hypothesis for benefits and risks of HRT, showing that younger have many benefits and few risks, particularly if therapy is predominantly focused on the estrogen component. We discuss these findings and put into perspective the potential risks of treatment, and suggest that we may have come full circle regarding the use of HRT. In so doing we propose that HRT should be considered as part of a general prevention strategy for women at the onset of menopause.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA. Electronic address: ral35@columbia.edu.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Lobo
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Pickar
authors.affiliation: National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
authors.forename: John C
authors.initials: JC
authors.lastname: Stevenson
authors.affiliation: Atherosclerosis Research Unit, Departments of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90022, USA.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Mack
authors.affiliation: Atherosclerosis Research Unit, Departments of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90022, USA.
authors.forename: Howard N
authors.initials: HN
authors.lastname: Hodis
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology; D001943:Breast Neoplasms / Q000517:prevention & control; D002118:Calcium / Q000097:blood; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000517:prevention & control; D003327:Coronary Disease; D003331:Coronary Vessels / Q000473:pathology; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008593:Menopause / Q000187:drug effects*; D008875:Middle Aged; D010024:Osteoporosis / Q000517:prevention & control; D017698:Postmenopause; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D018570:Risk Assessment; D016387:Women's Health
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004967:Estrogens; D002118:Calcium
keywords: Coronary heart disease; Estrogen; Hormone replacement therapy; Menopause; Mortality; Prevention