Abstract
The history of hormone replacement therapy (HRT) started in the 1960s, with very high popularity in the 1990s. The first clinical trials on HRT and chronic postmenopausal conditions were started in the USA in the late 1990s. After the announcement of the first results of the Women’s Health Initiative (WHI) in 2002, which showed that HRT had more detrimental than beneficial effects, HRT use dropped. The negative results of the study received wide publicity, creating panic among some users and new guidance for doctors on prescribing HRT. The clear message from the media was that HRT had more risks than benefits for all women. In the following years, a reanalysis of the WHI trial was performed, and new studies showed that the use of HRT in younger women or in early postmenopausal women had a beneficial effect on the cardiovascular system, reducing coronary disease and all-cause mortality. Notwithstanding this, the public opinion on HRT has not changed yet, leading to important negative consequences for women’s health and quality of life.
Highlights
The history of hormone replacement therapy (HRT) started in the 1960s, with very high popularity in the 1990s
A study performed in California between 2001 and 2004 [42] hypothesized that a decline in breast cancer incidence was linked to reduced HRT use
In France, the breast cancer rate decreased by 14.7% from 2003 to 2007, with a reduction in HRT use from 32% to 11% between the years 2001 and 2007 [45]
Summary
In the 20th century, the interest in menopausal disorder has been increasing, but it took a long time to realize the real impact of hormone depletion on women’s health. In spite of the benefits (such as a reduction of osteoporotic fracture and colon cancer) and of the not-increased risk of breast cancer or cardiovascular disease, the overall message on HRT remained negative After these announcements, the UK regulatory authorities issued an urgent safety restriction about HRT, recommending that doctors should prescribe the lowest effective dose for symptom relief, should use it only as a second-line treatment for the prevention of osteoporosis, and should not use it in asymptomatic postmenopausal women. A large controlled trial from Denmark (reported in 2012) demonstrated that healthy women taking combined HRT for 10 years immediately after menopause had a reduced risk of heart disease and death from heart disease [28] These data did not receive appropriate coverage by the media, and the fear regarding HRT has persisted.
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