Hormone Replacement Therapy for Postmenopausal Women

Benefits and Risks of HRT

The American College of Obstetricians and Gynecologists and other major medical organizations recommend against using HRT for primary or secondary prevention of cardiovascular disease, as it does not reduce and may increase the risk for coronary heart disease in postmenopausal women 7
HRT is effective for managing menopausal symptoms, including vasomotor symptoms and genitourinary symptoms, in postmenopausal women 1
HRT has confirmed benefits in preventing osteoporosis and fractures in postmenopausal women, with a significant reduction in hip fractures 2, 3
For every 10,000 women taking estrogen and progestin for 1 year, there may be 7 additional coronary heart disease events, 8 more strokes, 8 more pulmonary emboli, and 8 more invasive breast cancer cases, partially balanced against 6 fewer cases of colorectal cancer and 5 fewer hip fractures in postmenopausal women 1
HRT increases the risk of gallbladder disease and cholecystitis, with a relative risk of 1.8-2.5, in postmenopausal women 4, 3
Unopposed estrogen increases the risk of endometrial cancer in postmenopausal women with an intact uterus 5

The American College of Obstetricians and Gynecologists recommends considering HRT for menopausal symptom management, but not for prevention of chronic conditions, in postmenopausal women 1, 6
HRT is most appropriate within 10 years of menopause or under age 60, as higher risks are associated with initiation in women over 60 or more than 10 years past menopause 1
The lowest effective dose of HRT should be used for the shortest possible time, with consideration of transdermal routes, which have less impact on coagulation, in postmenopausal women 1

The North American Menopause Society and the American Heart Association recommend against using HRT for primary or secondary prevention of cardiovascular disease, as the Women's Health Initiative trials demonstrated that HRT does not reduce and may increase the risk for coronary heart disease in postmenopausal women 3, 7
Claims about superior safety of bioidentical hormones are not supported by scientific evidence, according to the American College of Obstetricians and Gynecologists 6

Initiating HRT solely for prevention of chronic conditions like osteoporosis or cardiovascular disease is not recommended, as the risks outweigh the benefits in postmenopausal women 1, 6
Continuing HRT for extended periods without reassessing the risk-benefit ratio can increase the risk of adverse effects, such as breast cancer and cardiovascular disease, in postmenopausal women 1
Using unopposed estrogen in women with an intact uterus increases the risk of endometrial cancer, and should be avoided, according to the American College of Obstetricians and Gynecologists 5