Abstract
Hormone replacement therapy (HRT) remains the most effective treatment for menopausal symptoms and has been shown to prevent bone loss and fracture. The progestogen is added to provide endometrial protection in women with an intact uterus. After the publication of the initial WHI (Women’s Health Initiative) results in 2002 reporting an overall increased risk of breast cancer, many women discontinued HRT. Despite the re-analysis of the results by subgroups of patients and updates with extended follow-up, much controversy remains, which we will analyze later in the text. Different types of estrogen or progestogen, as well as different formulations, doses, and durations, may play a role in HRT’s effects on breast tissue. Evidence states that conjugated equine estrogen (CEE), compared to estro-progestin therapy, shows a better profile risk (HR 0.79, CI 0.65–0.97) and that, among different type of progestins, those structurally related to testosterone show a higher risk (RR 3.35, CI 1.07–10.4). Chronic unopposed endometrial exposure to estrogen increases the risk of endometrial hyperplasia and cancer, whereas the association with progestins, especially in continuous combined regimen, seems to reduce the risk (RR 0.71, CI 0.56–0.90). HRT was also associated with a protective effect on colon cancer risk (HR 0.61, CI 0.42–0.87). Data about ovarian and cervical cancer are still controversial.
Highlights
The estrogen deprivation following the menopause status may impact on several aspects of health and quality of life determining vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM), cognitive dysfunction, sleep disturbance, and changes in bone metabolism.Hormone replacement therapy (HRT) remains the most effective treatment for VMS and GSM and has been shown to prevent bone loss and fracture
Evidence states that conjugated equine estrogen (CEE), compared to estro-progestin therapy, shows a better profile risk (HR 0.79, CI 0.65–0.97) and that, among different type of progestins, those structurally related to testosterone show a higher risk (RR 3.35, CI 1.07–10.4)
HRT was associated with a protective effect on colon cancer risk (HR 0.61, CI 0.42–0.87)
Summary
The estrogen deprivation following the menopause status may impact on several aspects of health and quality of life determining vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM), cognitive dysfunction, sleep disturbance, and changes in bone metabolism. A progestogen is added to provide endometrial protection in women with an intact uterus Despite this high prevalence of symptoms, it has been claimed that only 10–15% of women seeking medical help because of fear of the treatment and diffidence of clinicians in prescribing therapy [1]. After the publication of the initial WHI (Women’s Health Initiative) results in 2002 reporting an overall increased risk of breast cancer, heart disease, stroke, and venous thromboembolism, many women discontinued HRT. In a European survey published in 2016, 61% of women claimed they would not consider taking HRT because they were afraid of the increased risk of breast cancer (25%), cardiovascular disease (34%), and weight gain (26%) [4]. The cancer risk of HRT differs depending on many factors, so treatment should be individualized to identify the most appropriate dose, regimen, duration, and route of administration, using the best available evidence, with periodic reevaluation of the woman’s benefit-risk profile [1]
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