eMJA: The benefits of oestrogen following menopause: why hormone replacement therapy should be offered to postmenopausal women

Abstract

Recently, two major epidemiological studies found that hormone replacement therapy (HRT) in postmenopausal women increased the risk of breast cancer. One of the studies also found that HRT increased the risk of cardiovascular disease and thrombosis. As a consequence, women were advised to cease this therapy.

However, detailed analysis of these studies suggests that the conclusions may be erroneous. Other studies suggest that the timing of initiation of HRT for healthy women is critical to achieving a beneficial outcome.

When begun within 5 years of menopause in healthy women, oestrogen-based HRT results in far greater benefits than adverse outcomes.


There is substantial objective evidence that the benefits of HRT include:

Reduced distressing symptoms of menopause.

Reduced risk of osteoporotic fractures, dementia and colorectal cancer.

Improved wellbeing, quality of life; improved vaginal epithelium, sexual enjoyment and bladder capacity.

Improved cardiovascular system, with reduced myocardial ischaemia and cardiovascular-related death.

Increased longevity.


The adverse effects of HRT include:

Oral HRT doubles the risk of thromboembolism.

HRT promotes growth of pre-existing breast cancer.