A New Look at Menopausal Hormone Replacement: Evidence-Based Observations

Abstract

For nearly 50 years, physicians have been able to consider prescribing hormonal replacement therapy for postmenopausal patients. Early on, oestrogen replacement therapy was utilized alone, primarily for control of hot flushes and atrophic changes. Later, it was discovered that such therapy had preventive benefit in areas of osteoporosis, cardiovascular disease and other illnesses. In the 1970s, it became obvious that treatment with unopposed oestrogen led to an increased risk of endometrial cancer. This then stimulated the use of hormonal replacement therapy, which combined oestrogen therapy with the addition of either cyclic or continuous progestin. Hormonal replacement therapy dramatically reduced the risk of endometrial cancer, back even to lower levels than in untreated populations. As more evidence has developed, it appears there may be benefit of hormonal therapy or oestrogen therapy in still other areas: possibly stroke syndromes, tooth loss, cognitive dysfunction and Alzheimer's Disease, colon cancer, and adult onset macular degeneration. While these data are accruing, however, the debate has continued regarding the impact of hormonal therapy on the incidence of breast cancer and thromboembolic disease. In this presentation, the author will attempt to provide you with an overview of the latest research findings that impact upon these important issues, pro and con.