Hormone Replacement Therapy with Estrogen
Efficacy and Safety Considerations
- The U.S. Preventive Services Task Force recommends against the routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women (Grade D recommendation) 1
- Estrogen therapy has benefits, including increased bone mineral density (good evidence) 1
- Estrogen therapy has benefits, including reduced risk for fracture (fair to good evidence) 1
- Estrogen therapy has benefits, including reduced risk for colorectal cancer (fair evidence) 1
- Estrogen therapy has risks, including increased risk for breast cancer (good evidence) 1
- Estrogen therapy has risks, including venous thromboembolism (good evidence) 1
- Estrogen therapy has risks, including coronary heart disease (fair to good evidence) 1
- Estrogen therapy has risks, including stroke (fair evidence) 1
- Estrogen therapy has risks, including cholecystitis (fair evidence) 1
Clinical Applications
- Estrogen therapy can effectively relieve vasomotor symptoms, urogenital symptoms, and mood and sleep disturbances 4, 5
- The FDA recommends that estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman 4
Special Populations
- Hormone replacement therapy may be considered for managing menopausal symptoms in women with gynecological malignancies who experience premature menopause due to treatment 6
- For cervical cancer patients, HRT has not been shown to significantly influence disease-free and overall survival 6
- Estrogen may be a treatment option for both menopausal symptoms and bone health in young patients with non-breast cancers who experience chemotherapy-induced premature menopause 4
- Data in young women with spontaneous premature ovarian failure suggests no increased risk of breast cancer with full replacement doses 4