Hormone replacementIncreases endometrial cancer.
The addition of progestins to estrogen therapy reduces the risk of endometrial cancer to baseline.
Associated with a 50% reduction in vertebral fractures and 25%-30% reduction in the risk of hip fractures in observational studies, but prospective studies do not confirm reduction in fracture risk.
In postmenopausal women type 2 diabetes HRT has beneficial effects on lipoprotein concentrations.
In postmenopausal women type 2 diabetes HRT has beneficial effects on lipoprotein concentrations.
With estrogens and progesterones associated with a significant decrease in the risk of colorectal cancer.
Menopausal hormonal therapy patients tend to have improvements in lean body mass, insulin resistance, and lipid levels and a decrease in central adiposity.
There is a lower cardiovascular mortality in young, recently menopausal women receiving menopausal hormonal therapy compared with those who were not.
Menopausal hormonal therapy is not recommended for prevention of chronic disease prevention or management of weight gain.
Before starting treatment women should have a screening mammogram and Pap smear.
Current use of menopausal hormone therapy (MHT) to explains 7% of postmenopausal breast cancers, with over 90% of this burden explained by a long-term use of at least 5 years.
Current long-term use of oral contraceptives to explain 7% of premenopausal breast cancers.
Is safe for <5 years as a treatment of symptoms.
Hormonal therapy is appropriate and safe for symptom relief in younger, recently menopausal women without contraindications and the risks identified in the WHI trials apply primarily to women who initiate hormonal therapy after age 60 and more than a decade after menopause.
Patient acceptance is poor, with 60% of women continuing therapy for < 6 months and only 8% continuing for as long as 2 years.
Effective in preventing postmenopausal bone loss and bone density is preserved as long as treatment is continued.
Estrogen therapy has been shown in several studies to increase BMD from 2% to 7% at all sites and to prevent both vertebral and hip fractures in post menopausal women.
The average rate of progression of subclinical atherosclerosis is slower in healthy postmenopausal women taking unopposed estrogen replacement therapy with 17 B-estradiol than in women taking placebo.
Can increase HDL and decrease LDL.
Short-term hormonal therapy with estrogen alone or estrogen and progesterone in patients who have a BRCA mutation is not associated with increase risk of breast cancer, and factor may have an associated decreased risk.
Observational studies and randomized trials of hormonal therapy in breast cancer survival have conflicting results and the use of estrogen plus progesterone, especially, is not endorsed.
Prevents osteoporosis, reduces cardiovascular risk, relieves menopausal vasomotor symptoms and urogenital atrophy.
Reduces risk of colorectal cancer.
Postmenopausal women taking HRT have a smaller increase in systolic blood pressure over time than those not taking HRT.
May increase the risk of invasive lobular breast cancer, but does not increase risk of invasive ductal carcinoma.
Not associated with a higher risk of breast cancer if treatment lasts < 5 years.
May be more effective in preventing fractures among women who have osteoporosis than in women who do not.
Reduces nonvertebral fractures by 35% when women commence therapy before age 60 years.
For hip and wrist fractures in younger women, the reduction is closer to 50%.
One of the most common reasons for discontinuing treatment is menstrual bleeding the frequency of which can be decreased by the use of daily progesterone.
Reduction in risk of fracture occurs after a year or so of using hormone therapy.
Prothrombotic findings in patients with hormonal replacement therapy include decreased levels of antithrombin, protein C and S.
A population of women that begin hormonal therapy at menopause for 5 years will prevent an estimated 0.3 hip fractures per 1000 users compared to a group of women beginning 5 years of hormonal therapy at age 60 where 1 hip fracture per 1000 users can be prevented.
5 years of hormonal therapy beginning at age 50-60 is associated with a greater incidence of breast cancer and stroke than a reduction in the absolute incidence of hip fracture.
Incidence of bone fracture after hormone therapy returns to levels of never-users within a year of stopping hormone use.
Low dose estrogen preparations defined as containing less than 0.3 mg/d of conjugated estrogen, 0.5 mg/d or less of oral estradiol, or 0.025 mg/d or less of transdermal estradiol.
Doses of 0.45 mg/d of conjugated estrogen and 0.035 mg/d of transdermal estradiol are considered intermediate doses of hormonal therapy.
Transdermal estrogen therapy has advantages compared with oral therapy, especially for women with obesity or cardiovascular disease risk factors.
All estrogen patches contain estradiol and your change to only once or twice weekly, and result in very stable blood levels.
Transdermal estrogen avoids the hepatic first pass effect, and there is not increased levels of coagulation factors or hepatic binding globulins..
No increase in venous thromboembolism risk is seen with transdermal estradiol, even in women with obesity or underlying thrombophilia.
If higher or lower estradiol doses or natural progesterone are preferred patches contain both estradiol and progesterone drugs are available.
Conjugated equine estrogens used to relieve vasomotor symptoms of menopause is associated with about twice the risk of venous thrombosis compared with estradiol (Smith NL et al).
Oral contraceptives containing estrogen are an efficacious way to manage hot flashes prior to menopause.
Healthy women in their late 40s and early 50s or a good candidates for oral contraceptives.
For healthy women with bothersome hot flashes younger than 60 years or within 10 years of the onset of menopause, benefits of hormone therapy typically outweighs the risks.
The Woman’s Health Initative clinical trial identified no increased risk of heart disease in women randomized to receive estrogen or estrogen-progestogen therapy who were younger than 60 years or within 10 years of menopause onset.
18 year follow-up data from the WHI trial revealed no difference in the long term all-cause and cause-specific mortality in women treated with HT versus placebo.