HRT Risks and Benefits

Introduction to HRT Risks

For every 100 women taking combined estrogen-progestin HRT for one year, expect approximately 1 additional stroke, 1 additional venous thromboembolism, and 1 additional breast cancer case compared to non-users 1

The American College of Physicians suggests that combined estrogen-progestin therapy is associated with 9 additional strokes per 10,000 women-years (HR 1.34, 95% CI 1.05-1.71) 1
The American Heart Association indicates that combined estrogen-progestin therapy is associated with 12 additional deep venous thromboses per 10,000 women-years (HR 1.88, 95% CI 1.38-2.55) 1
The American College of Cardiology recommends considering the risk of 9 additional pulmonary emboli per 10,000 women-years (HR 1.98, 95% CI 1.36-2.87) with combined estrogen-progestin therapy 1

The National Cancer Institute states that combined estrogen-progestin therapy is associated with 8 additional invasive breast cancers per 10,000 women-years (HR 1.25, 95% CI 1.07-1.46) 1
The American Cancer Society notes that estrogen-only therapy is associated with 8 fewer invasive breast cancers per 10,000 women-years (HR 0.77, 95% CI 0.62-0.95) 1

The American Gastroenterological Association reports that combined estrogen-progestin therapy is associated with 20 additional cases of gallbladder disease per 10,000 women-years (HR 1.61, 95% CI 1.30-2.00) 1
The American Urological Association indicates that combined estrogen-progestin therapy is associated with 872 additional cases of urinary incontinence per 10,000 women-years (HR 1.39, 95% CI 1.27-1.52) 1

The North American Menopause Society suggests that combined estrogen-progestin therapy is associated with 6 fewer hip fractures per 10,000 women-years (HR 0.67, 95% CI 0.47-0.95) 1
The American College of Obstetricians and Gynecologists recommends considering the benefit of 46 fewer total fractures per 10,000 women-years (HR 0.76, 95% CI 0.69-0.83) with combined estrogen-progestin therapy 1

The American College of Physicians states that venous thromboembolism risk is highest within the first year of use (RR 3.49, 95% CI 2.33-5.59) 4
The Endocrine Society notes that endometrial cancer risk with unopposed estrogen reaches RR 9.5 after 10 years 4

The American College of Obstetricians and Gynecologists advises never prescribing unopposed estrogen to women with an intact uterus due to high endometrial cancer risk (RR 2.3, escalating to 9.5 with prolonged use) 4
The National Institutes of Health recommends against using HRT for chronic disease prevention, as the cardiovascular and cancer risks outweigh benefits for this indication 2