Benefits Of Hormone Replacement Therapy Research Articles

Whose menopause revolution? Investigating the UK’s ‘Davina effect’ and the contemporary menopause market

Having made two documentaries about menopause, broadcast on Channel 4 in the UK 2021 and 2022, enduringly popular British TV presenter Davina McCall’s films are perceived to have had such a social impact that she now has the rare distinction of having an ‘effect’ named after her. The first film, Sex, Myths and the Menopause, is credited with diminishing the stigma historically surrounding menopause, while extolling the benefits of Hormone Replacement Therapy (HRT) for some to treat menopause symptoms. Hence, when requests for HRT spiked after the first film, ‘the Davina effect’ was adopted by the media to explain the widespread ensuing HRT shortage. This article is not focused on interrogating the films themselves but unpacking the media narrative that followed in the uses of the term ‘the Davina effect’. Its corpus comprises UK press coverage of the ‘menopause revolution’ and of the Davina documentaries; textual analysis of the films; and testimonies and research drawn from the medical and health professions, while utilising existing media and cultural studies paradigms to provide conceptual context, situating the ‘Davina effect’ as the latest novel entry in a long-standing history of media effects debates. While the films have been praised for bolstering a new era of menopause awareness, this article considers how ‘the Davina effect’ instantiates and services how the so-called ‘menopause revolution’ (Gordon, 2021) has evolved largely in neoliberal terms, regularly centring the need to respond to the perceived crises of middle-class white women, rather than a more intersectional and inclusive conception of menopause. Furthermore, it apportions knowledge, fear and blame around HRT shortages in a manner which deflects attention from the larger economic, political and cultural contexts that have nurtured the ensuing alarm. Yet, importantly, the Davina effect may also facilitate a transgressive image of menopausal women as determinedly contesting their marginalisation.

Hormone Replacement Therapy and Pulmonary Hypertension: A Review of the Literature.

Pulmonary hypertension (PH) is a multifactorial condition that encompasses a group of diseases characterized by a progressive increase in pulmonary vascular resistance and pulmonary arterial pressure, ultimately leading to right heart failure and death. The primary goals of PH treatment are to lower pulmonary arterial pressure, alleviate symptoms such as shortness of breath and chest pain, address modifiable risk factors, and manage the underlying cause, often a common advanced disease like chronic obstructive lung disease or left heart disease. While sex is an unchangeable risk factor for PH development, the presence or absence of estrogens has a significant influence on its progression. Hormone replacement therapy (HRT) is the recommended form of estrogen therapy for postmenopausal women, but only in carefully selected cases. However, a paradox arises, as some research suggests HRT benefits women, while other studies highlight its risks. This review provides a comprehensive analysis of the literature on the role of HRT in PH.

Hormone replacement therapy for menopausal mood swings and sleep quality: The current evidence.

Marked alterations in the normal female hormonal milieu in the perimenopausal period significantly affect women's health, leading to decreased well-being, psychological distress, and impaired quality of life. Common menopausal symptoms include hot flashes, sleep and mood changes, fatigue, weight gain, and urogenital disturbances. Clinicians often neglect mood swings and disrupted sleep, although those can significantly limit the productivity of women and impair their cognitive function and mental health. Evidence-based management should include a personalized, holistic approach to alleviate symptoms and careful consideration of the risks vs benefits of hormone replacement therapy (HRT), with due consideration of personal preferences. A research paper in the recent issue of the World Journal of Psychiatry by Liu et al investigated the role of HRT in altering mood changes and impaired sleep quality in menopausal women, which helps us to understand the benefits of this treatment approach.

Potential benefits of hormone replacement therapy on cardiovascular and kidney outcomes in postmenopausal women with chronic kidney disease.

Hormone replacement therapy (HRT) is recommended for alleviating vasomotor symptoms or preventing bone loss in postmenopausal women. This study aimed to investigate the impact of hormone replacement therapy on major adverse cardiovascular events, kidney failure, and mortality in women with chronic kidney disease (CKD). This population-based cohort study analyzed data from the National Cancer Screening Program and the national health examination of South Korea. Data on postmenopausal women were extracted from the 2009 National Cancer Screening Program. Among these postmenopausal women, those with CKD without kidney replacement therapy were selected through a national health examination from 2009 to 2013. The study outcomes were the risks of major adverse cardiovascular events, kidney failure, and all-cause mortality according to hormone replacement therapy. A total of 768,279 postmenopausal women with CKD were enrolled in this study; of these women, 13.8% (N = 106,052) had a history of hormone replacement therapy. The user and non-user groups differed with respect to baseline characteristics, with the latter being older and having risk factors for cardiovascular disease. After adjustment for confounding factors, the group exposed tohormone replacement therapyshowed lower risks of major adverse cardiovascular events, kidney failure, and all-cause mortality. This study suggests the potential benefits of hormone replacement therapy in postmenopausal women with CKD and highlighted its potential advantages for cardiovascular and kidney outcomes.

Protocolo de tratamiento hormonal sustitutivo en la posmenopausia

Hormone replacement therapy (HRT) is a treatment for postmenopausal women to improve quality of life and the adverse effects associated with hormonal deficiencies that occur at this stage of life. In most healthy women under 60 years of age who are in early menopause (within the first 10 years of the onset of menopause), the benefits of HRT outweigh the risks. Initiation of HRT in the 60-70 age group requires an individualized risk/benefit calculation, consideration of other available drugs, and the lowest effective dose. HRT should generally not be started after age 70. Estrogen formulations are the most effective therapeutic option available and the addition of progesterone is intended to protect against the consequences of systemic estrogen therapy in women with intact uteruses.

Hormone replacement therapy perspectives.

Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), was looked upon as a fountain of youth that kept women young and reduced cardiovascular disease. This led to a large-scale study called the Women's Health Initiative (WHI) that was conducted to show the cardiovascular benefits of HRT. This study was suspended early because of adverse side effects. The USFDA responded by slapping a "black box" warning on all HRT products. USFDA-approved bioidentical HRT formulations are safe and effective. We propose that these formulations have the "black box" warning removed so that doctors feel more confident in prescribing these products for symptoms of menopause and chronic conditions such as cardiovascular health. We propose eliminating the sale of products containing medroxyprogesterone acetate (MPA) because of the increased risk of heart attacks and breast cancers associated with this medication.

Hormone replacement therapy in women with iatrogenic premature ovarian insufficiency after radiotherapy for cervical cancer: A retrospective cohort and survey study

ObjectivesThis study assessed the uptake of hormone replacement therapy (HRT) in cervical cancer patients with iatrogenic menopause. Survival in relation to HRT use was assessed via a retrospective chart study, and the severity of menopausal symptoms, motivations and barriers to starting HRT were examined via questionnaires. Study designIn total, 293 women under the age of 51 and treated with radiotherapy for cervical cancer between 2010 and 2020 were identified. Medical records were searched for information on HRT use. If still living, women were sent digital questionnaires addressing menopausal symptoms, quality of life (QoL) and potential barriers and motivations concerning HRT use. Univariable data were analysed using Mann-Whitney U, chi-square, and Fisher's exact test, while logistical regression was used to analyse relationships between certain variables and use of HRT and survival. ResultsOverall HRT uptake was 78.1 %, which was related to age and Charlson Comorbidity Index, but independent of the duration of radiotherapy or FIGO stage. Overall survival was higher for HRT users (χ2(1) = 4.3, p = 0.038). Questionnaires were sent to 193 patients and 100 completed it (response rate 51.8 %). Main reasons for HRT use were relief of hot flushes and improvement in QoL. For women below age 51, QoL was indeed higher for current HRT users than for non-HRT users (EQ-index 0.8 vs. 0.7, p = 0.008). ConclusionsHRT prescription rate was inversely correlated with age. Survival was not negatively affected by HRT use. It is important to stress the benefits of HRT and address women's fears regarding its use.

Sharing the multidisciplinary clinical approach to peri- and postmenopausal women: A Delphi consensus among Italian gynecologists, endocrinologists, and cardiologists for an integrated and optimal approach to clinical practice.

The critical phase of perimenopausal period is marked by a reduction in estrogen levels, leading to various clinical issues (vasomotor and neurodegenerative symptoms, increased osteoporosis risk and cardiovascular risk). These complex clinical scenarios pose challenges to clinicians in providing the right support for diagnosis and treatment. A group of Italian cardiologists, endocrinologists, and gynecologists conducted a survey among expert colleagues to assess consensus on controversial issues and best practices for screening and treating peri- and postmenopausal women. The Delphi methodology was used to analyze responses from a qualitative expert panel comprising 25 cardiologists, 25 endocrinologists, and 25 gynecologists, selected nationwide. Two consecutive questionnaires were proposed between February and May 2023. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. The results of this Delphi Consensus have been shared by the leading scientific societies: Italian Society of Cardiology, Italian Society of Endocrinology, Italian Society of Gynecology and Obstetrics, and Italian Hospital Obstetricians Gynecologists Association. The experts highlighted comorbidities and hormone deprivation as crucial clinical problems to be evaluated in perimenopausal women, requiring investigation from cardiovascular and endocrinologic perspectives to assess cardiovascular risk, involving the use of BMI, standard blood samples, endocrine-metabolic tests, and lifestyle assessment, particularly in women with higher cardiovascular and metabolic risks candidates for hormone replacement therapy (HRT). The experts also agreed on the benefits of HRT in improving lipid metabolism and reducing insulin resistance, thereby mitigating the metabolic risks associated with menopause. However, this therapy should be tailored considering individual women's comorbidities and thrombotic risk.

Risks and benefits of hormone replacement therapy in reproductive age women after hematopoietic stem cell transplants: a narrative review

Risks and benefits of hormone replacement therapy in reproductive age women after hematopoietic stem cell transplants: a narrative review

Women's knowledge, attitude, and practice toward menopause and hormone replacement therapy in Saudi Arabia

Background: Hormonal changes associated with menopause have been linked to a number of medical and psychological symptoms. This study aimed to assess women›s knowledge, attitudes, and practices toward menopause and hormone replacement therapy (HRT) in Saudi Arabia. Methods: In this cross-sectional study, participants were randomly selected using a proportional cluster sampling method in 2023. The target population in this study is women aged 18 years and older in Saudi Arabia. Data were collected via an online questionnaire. Results: This study included a total of 1,083 participants. The majority of them (75.6%) were between the ages of 18 and 34. Our study revealed that more than half of the study population had good knowledge about menopause (56.0%). However, more than half of them (56.1%) had a poor level of knowledge about the benefits and risks of HRT. The mean attitude score toward HRT was 2.24 ± 0.024. Moreover, mood swings were the most commonly recognized symptom of menopause, and social media was the most commonly reported source of information. Almost half of them identified the advantages of HRT. Furthermore, women who had divorced, widowed, or were students had significantly more knowledge about menopause. On the other hand, widowed women, those who achieved higher diplomas and elementary school, were significantly associated with a good level of knowledge toward the risks and benefits of HRT. Conclusion: Our study concluded that women in Saudi Arabia had sufficient knowledge and attitude toward menopause. However, they showed inadequate knowledge about the benefits and risks of HRT.

Supporting Transgender Adolescents: Best Practices

The provision of gender-affirming health care is crucial to address the health disparities faced by transgender and gender-diverse (TGD) adolescents. In Canada, primary care nurse practitioners play a pivotal role in hormone replacement therapy and can facilitate gender exploration among TGD youth and their families. To optimize care of this population and minimize adverse health outcomes, such as depression, anxiety, and suicide, nurse practitioners must address barriers to care, consider individual risks and benefits of hormone replacement therapy, provide early interventions, and ensure access to inclusive health care spaces.

Health implications and management of early estrogen loss

The author discusses the health risks associated with early menopause and the benefits of hormone replacement therapy to mitigate these risks and alleviate hypoestrogenic symptoms as appropriate for individual patients.

Pharmacological interventions and hormonal therapies for depressive symptoms in peri- and post-menopausal women: a network meta-analysis of randomized controlled trials

Although significant portion of women experience depressive symptoms during or after menopausal transition, there has been considerable controversy over the benefits of hormone replacement therapy (HRT) and antidepressants due to insufficient evidence supporting the superiority of either treatment. This frequentist model based network meta-analysis (NMA) included randomized controlled trials (RCTs) of menopausal depression symptoms management in menopausal women. Seventy RCTs involving a total of 18,530 women (mean age 62.5) were analyzed. The results demonstrated that fluoxetine plus oral HRT [standardized mean difference (SMD)=-1.59, 95% confidence interval (95%CIs)=-2.69 to -0.50] were associated with the largest improvement in depressive symptoms than placebos in overall menopausal women. Similar findings were also noted in the subgroup of participants with a definite diagnosis of depression, while no pharmacological or hormone replacement therapy was better than placebo in the subgroup of post-menopausal women (amenorrhea > 1 year) or in patients without diagnosis of depression. This NMA presented evidence that fluoxetine plus HRT may be beneficial to menopausal women with a definite diagnosis of depression but not to those without depression or post-menopausal women.Trial registration: PROSPERO (CRD42020167459).

#2647 MENOPAUSAL HORMONE THERAPY AND RISK OF DEMENTIA IN WOMEN WITH PRE-DIALYSIS CKD: A NATIONWIDE OBSERVATIONAL COHORT STUDY

Abstract Background and Aims The risk of dementia is increased in postmenopausal women. The incidences of premature menopause and dementia are increased in patients with chronic kidney disease (CKD). Therefore, the potential benefit of hormone replacement therapy (HRT) for cognitive function may be a more critical issue in CKD patients. Method Menopausal women over 40 years with or without HRT were identified through the National Health Screening questionnaire in 2009. Among the subjects, those newly diagnosed with CKD between 2009 and 2013 were enrolled. HRT was used as an exposure variable and was followed from the day when CKD was diagnosed to December 2019. The hazard ratio (HR) of dementia was evaluated using a Cox proportional hazards regression analysis. Results We included 755,426 postmenopausal women with CKD. The median follow-up period was 7.3 (IQR, 5.8-8.7) years. All-cause dementia occurred in 107,848 (14.3%), Alzheimer's disease in 87,833 (11.6%), and vascular dementia in 10,245 (1.4%). HRT was significantly associated with a lower risk of dementia in the adjusted Cox regression model (all-cause dementia: hazard ratio [HR] 0.796, 95% confidence interval [95% CI] 0.776-0.816, P < 0.001; Alzheimer's disease: HR 0.795, 95% CI 0.773-0.818, P < 0.001; vascular dementia: HR 0.803, 95% CI 0.743-0.868, P < 0.001). Conclusion HRT was significantly associated with a lower risk of CKD-related cognitive dysfunction in postmenopausal women. Prospective studies on whether HRT lowers the risk of dementia in menopausal women with CKD are needed.

(105) The Discovery of New Incredible Positive Actions of Hormone Replacement Therapy and Sex in Menopause

Abstract Introduction Every year, two or more benefits of the use of hormone replacement therapy (HRT) in menopause and andropause appear in medical literature. We present an extensive review of the literature describing the classical and novel benefits of hormonal replacement therapy and sex in menopause. Additionally, we present recent findings from our own patient population. Objective To contribute to the presently known benefits of the use of HRTs, and additionally to present new findings from our own practice not previously described. Methods We conducted an extensive literature review and described our own experience and findings within our centers. Results `- In the area of prevention and treatment of genitourinary syndrome of menopause, we have found: - Prevention and treatment of false positive cervical dysplasia in perimenopause. - Prevention and treatment of vulvar, labial, and vaginal occlusion in late menopause. - Prevention and treatment of recurrent urinary tract infections in geriatric patients for prevention of sepsis, secondary pneumonia, and even death. - Prevention and treatment of clitoral atrophy, phimosis, and urethral caruncles - Dermatology: We have found: - Prevention and treatment of wrinkles, alopecia related, postmenopause. - Prevention in prostrated geriatric patients of decubitus ulcers. - Internal Medicine: prevention of obesity, decreased metabolic rate, and insulin resistance. - Ophthalmology: - Prevention and treatment of macular degeneration. - Prevention of glaucoma (increased intraocular pressure), most notably in primary open- angle glaucoma. - The prevention of aging of optic nerve and neuroprotection of retinal cells. - Oncology: - Prevention of kidney cancers, and breast cancer (only estrogen hormone replacement therapy). - Enhanced visualization of the transformation zone during cervical cancer screening - Gastroenterology: protection of the gut microbiome and serum metabolome, especially in premature ovarian insufficiency - Dentistry: prevention of tooth loss through decreased gingival inflammation and periodontitis, mandibular bone loss, and oral dysesthesia. - Neurology: - Protection against intracranial aneurysm rupture in ovariectomized mice. - The prevention of Parkinson’s and Alzheimer’s disease - Rheumatology: prevention of rheumatoid arthritis. Conclusions To demonstrate the number of studies with the anti-aging mechanism of the use of HRT. How this knowledge, alongside our own findings of hundreds of menopausal women within our centers justify the generalized use of this therapy. Disclosure No

(072) What Kind of Specialists Should Know About HRT?

Abstract Introduction Hormone Replacement Therapy (HRT) use has recently been a topic of debate amongst clinicians. The discussion has been most prevalent in the fields of gynecology, urology, and endocrinology. Current research suggests HRT can prevent the development of lethal diseases such as myocardial infarction, osteoporosis, diabetes mellitus, Alzheimer's disease, Parkinson’s disease, and genitourinary syndrome of menopause. Objective To raise awareness of HRT as a prophylactic measure to treat a variety of diseases in multiple organ systems, we recommend providing this information across multiple medical specialties to warrant the use of HRT amongst patients. Specialists including obstetricians and gynecologists, urologists, cardiologists, neurologists, dermatologists, psychiatrists, ophthalmologists, orthopedics, wound care specialists, sexologists, sex therapists, psychologists, rheumatologists, immunologists, infectious disease specialists, cosmetic surgeons, endocrinologists, and geriatricians should be aware of the benefits of HRT and how they can incorporate it into patient care. Methods Based on our own experience, for more than 40 years and the continued management of postmenopausal women, we have realized the importance that physicians, in specialties other than obstetrics and gynecology must be aware of the use of this therapy in their specific field. For example, approximately 60% of depression diagnoses in perimenopausal years can be treated with greater efficacy with hormone replacement therapy rather than antidepressants prescribed by psychiatrists. These findings have been confirmed in the current literature, however awareness amongst the various specialties is very poor. Results HRT plays a significant role in treating silent killers such as myocardial infarction, osteoporosis, diabetes mellitus, Alzheimer’s disease, Parkinson’s disease, and Genitourinary syndrome of menopause. Conclusions Previously, the role of HRT was not clearly established. Current data suggests HRT provides many benefits including a reduction in mortality. Through recent research and published literature, the consensus of the benefits and strategies of HRT have been established. However, the use of HRT is currently under-prescribed. This creates an opportunity to bring awareness to clinicians, thereby improving the lives of patients. Disclosure No

Hormone replacement therapy and COVID-19 outcomes in solid organ transplant recipients compared with the general population

Exogenous estrogen is associated with reduced coronavirus disease (COVID) mortality in nonimmunosuppressed/immunocompromised (non-ISC) postmenopausal females. Here, we examined the association of estrogen or testosterone hormone replacement therapy (HRT) with COVID outcomes in solid organ transplant recipients (SOTRs) compared to non-ISC individuals, given known differences in sex-based risk in these populations. SOTRs ≥45 years old with COVID-19 between April 1, 2020 and July 31, 2022 were identified using the National COVID Cohort Collaborative. The association of HRT use in the last 24 months (exogenous systemic estrogens for females; testosterone for males) with major adverse renal or cardiac events in the 90 days post-COVID diagnosis and other secondary outcomes were examined using multivariable Cox proportional hazards models and logistic regression. We repeated these analyses in a non-ISC control group for comparison. Our study included 1135 SOTRs and 43 383 immunocompetent patients on HRT with COVID-19. In non-ISC, HRT use was associated with lower risk of major adverse renal or cardiac events (adjusted hazard ratio [aHR], 0.61; 95% confidence interval [CI], 0.57-0.65 for females; aHR, 0.70; 95% CI, 0.65-0.77 for males) and all secondary outcomes. In SOTR, HRT reduced the risk of acute kidney injury (aHR, 0.79; 95% CI, 0.63-0.98) and mortality (aHR, 0.49; 95% CI, 0.28-0.85) in males with COVID but not in females. The potentially modifying effects of immunosuppression on the benefits of HRT requires further investigation.

Preparation of pumpkin oil-based nanoemulsion as a potential estrogen replacement therapy to alleviate neural-immune interactions in an experimental postmenopausal model

As estrogen production decreases during menopause; the brain's metabolism tends to stall and become less effective. Estrogen most likely protects against neurodegeneration. Consequently, a comprehensive study of the benefits of hormone replacement therapy as a neuroprotective effect is urgently required. This study was designed to fabricate pumpkin seed oil nanoparticles (PSO) in nanoemulsion form (PSO-NE) and investigate their potential role in attenuating the neural-immune interactions in an experimental postmenopausal model.Sixty female white albino rats were divided into six groups: control, sham, ovariectomized (OVX), and three OVX groups treated with 17β-estradiol, PSO, and PSO-NE respectively. Transmission Electron Microscopy (TEM), and particle size analyzer were performed for nanoemulsion evaluation. Serum levels of estrogen, brain amyloid precursor protein (APP), serum levels of nuclear factor kappa B (NF-κβ), interleukin 6 (IL-6), transthyretin (TTR), and synaptophysin (SYP) were evaluated. The expression of estrogen receptors (ER-α, β) in the brain tissue was estimated. The findings revealed that the approached PSO-NE system was able to reduce the interfacial tension, enhance the dispersion entropy, lower the system free energy to an extremely small value, and augment the interfacial area. PSO-NE, showed a significant increase in the levels of estrogen, brain APP, SYP, and TTR accompanied with a significant increased in the expression of brain ER-α, β compared to the OVX group. In conclusion, the phytoestrogen content of PSO exhibited a significant prophylactic effect on neuro-inflammatory interactions, ameliorating both estrogen levels and the inflammatory cascades.

O-267 Uterine volume is dramatically decreased in Stem Cell Hematopoietic Transplantation childhood survivors whatever the conditioning regimen. A case-control MRI study in the L.E.A cohort

Abstract Study question What is the impact of the type of myeloablative conditioning (MAC) regimen applied for hematopoietic stem cell transplantation (HSCT) on uterine volume of childhood leukemia survivors? Summary answer Uterine volume is significantly decreased after HSCT. Not only Total Body Irradiation (TBI), but also high-dose chemotherapy-based regimens containing alkylating agents induce uterine damage. What is known already Premature ovarian failure after HSCT is well known, as well as the uterine damage induced by TBI on uterine volume. A few studies have reported smaller uterus after HSCT in women treated with chemotherapy only. In these studies, uterus volume was assessed by a transabdominal and/or transvaginal ultrasonography, and primary diagnosis, age at treatment and chemotherapy regimen were heterogeneous. These preliminary results suggested that alkylating agents could induce uterine damage, as well as they induce fibrosis and vascular damage in ovarian stroma. The impact of chemotherapy on myometrium and uterus is still few investigated. Study design, size, duration A prospective multicentric national study was conducted between 2017, November and 2021, June in 16 University Teaching Hospitals that are following more than 4 500 childhood acute leukemia survivors enrolled in the L.E.A cohort. We included 88 adult women treated for a childhood acute leukemia with HSCT and who agreed a pelvic MRI assessment. Every case was matched 1:1 to control women who underwent MRI for benign ovarian cysts or benign pelvic pathology. Participants/materials, setting, methods Pelvic MRI scans were performed with a 1.5-T or 3T magnetic resonance scanner, including diffusion-weighted imaging sequences. Scans were centralized for a double-blinded lecture by two radiologists. The main outcome was the uterine volume. The secondary outcomes were uterine body-to-cervix ratio and apparent diffusion coefficient (ADC). Univariate and multivariate analyses have investigated the association of clinical and imaging variables with conditioning regimen and age at HSCT. Main results and the role of chance The mean age in HSCT group was 26.5 + 6.3 years. Mean age at HSCT was 9.1 + 0.3 years with a mean follow-up of 16.4 + 0.5 years. Among the 88 women included in HSCT group, two groups of conditioning regimens have been compared to the control group: a chemotherapy-only MAC regimen group with high dose of alkylating agents (n = 34) and one TBI-based regimen group (n = 52). Two MRI scans were not available. Among HSCT group, 75 women were considered as “normally impregnated” by estrogens, by hormone replacement therapy (HRT) for premature ovarian insufficiency (POI) or thanks to a residual ovarian function. Uterine volume was significantly decreased both after chemotherapy-only MAC regimen and after TBI, with respectively 45.3 + 5.6 and 19.6 + 1.9 mL Vs 79.7 + 3.3 mL in control population (p < 0.01). In chemotherapy-only MAC regimen group, uterine volume was dramatically decreased in POI women without HRT compared to those having a hormonal impregnation (15.2 + 2.6 Vs 49.3 + 6 mL, p < 0.05). In contrast, after TBI, uterine volume was similar in all women, with no positive effect of HRT on uterine volume (respectively 16.3 + 2.6 Vs 20.1 + 2.2 mL). Limitations, reasons for caution The number of pregnancies obtained spontaneously or after oocyte donation in our study population was too low to evaluate the obstetrical impact of uterine damage caused by non-TBI regimens. Wider implications of the findings Our results provide strong evidence that a MAC regimen containing high dose of alkylating agents could induce uterine damage. In these sub-group of women, HRT increases the volume of the uterus compared to non-treated women. After TBI, uterine volume is dramatically decreased, with no benefit of HRT on it. Trial registration number NCT 03583294

Hormone replacement therapy - Current recommendations.

Menopause is a major life event that can affect women in several ways. Its onset marks the end of the reproductive life cycle, and its impact can be both short and long term. Menopause is often a gradual process, preceded by a transitional period known as perimenopause. The average age of menopause in the UK is 51. The clinical manifestations of menopause result from the eventual exhaustion of oocytes within the ovaries. This leads to a chronic hypo-estrogenic state, which in the short term causes menopausal symptoms and over a long term, has an impact on bone and cardiovascular health. There has been a steep drop in the prescription of hormone replacement therapy (HRT) following the publication of the Women's Health Initiative Study and the Million Women Study. It is currently estimated that approximately a million women in the UK are taking HRT for control of their menopausal symptoms. This review summarises the current recommendations for HRT use in menopausal women. The benefits of HRT in improving the symptoms of menopause are discussed as well as the potential role of HRT in managing long-term sequelae is covered. Evidence pertaining to the potential risks associated with HRT is also be reviewed.