Hormone replacement therapy.

Abstract

An estimated 10 million women in the United States currently use hormone replacement therapy (HRT) for relief of menopausal symptoms or prevention of chronic disease conditions such as osteoporosis. 1 However, the early termination of the Women’s Health Initiative (WHI) study, which examined the use of estrogen as primary prevention for osteoporosis and other chronic conditions, has led to reevaluation of the use of exogenous estrogens. In January 2003, the United States Food and Drug Administration (FDA) revised the approved indications for estrogen alone or in combination therapy to include treatment of postmenopausal symptoms or prevention of osteoporosis, stating, “when these products are being prescribed solely for the prevention of postmenopausal osteoporosis…estrogens and combined estrogen-progestin products should only be considered for women with significant risk of osteoporosis that outweighs the risks of the drug.” 1 The FDA recommended prescribing nonestrogen therapies (eg, bisphosphonates, selective estrogen receptor modulators, calcitonin, parathyroid hormone) for the treatment and prevention of osteoporosis in lower risk patients and advises use of estrogen therapy at the lowest dose for the shortest duration possible. 1