Hormone replacement therapy

Aim

To update SBU Report 131/96 Treatment With Estrogen and to compile the scientific evidence on Hormone Replacement Therapy (HRT), its effects on the climacteric syndrome itself, and its preventive effects following menopause.

Method

A systematic search of the databases for publications since 1995 has identified the scientific literature concerning the topic. Relevant studies were reviewed using a format to evaluate quality and extract data. Two experts reviewed all articles.

Results

Many women who experience problems during menopause, eg, hot flushes and sweating, are helped by estrogen. None of the research suggests that such short-term treatment would result in any measurable increase in cancer risks. However, there is a higher risk for blood clots, particularly during the early years of treatment.

Treatment with estrogen agents of low potency has a good effect on vaginal and urinary tract symptoms.

An increased risk for breast cancer has been found with treatment that continues over a longer period. The risk increases with time, but remains moderate even with long-term treatment.

Treatment increases the risk for cancer in the endometrium if it is administered without the addition of gestagen. Adding gestagen is standard practice in Sweden.

More research is needed to assess the effects on ovarian, colon, and skin (malignant melanoma) cancer.

A comprehensive view does not lend support to the idea that HRT would have any preventive effects on myocardial infarction, as some claim. Current knowledge suggests that treatment would be motivated only to prevent disease in the heart or vascular system. A confirmed conclusion would, however, require larger and more rigorous studies.

No conclusions can be drawn as to whether or not estrogen affects cognition, nor whether treatment prevents osteoporosis or fracture except in certain risk groups.

The costs of estrogen treatment are moderate. Hormone replacement therapy in menopause is probably cost effective.