Resurgence of renewed interest in the use of HRT in pre- and post-menopausal women

Menopause is that time in the reproductive phase of a woman where by the levels of circulating estrogen diminishes to such low levels as to cause physical, psychological and sexual disturbances. At or around menopause (between 48 to 52 years) there is a decline in the ovarian functions and in the amounts of hormones produced by hypothalamus-FSH and LH which results in decrease in the ovarian hormones. While cessation of periods can be welcome to many a women, the wide ranging effects of lack of estrogen can be discomforting to an equal many. One alternative to overcome the hazards of menopausal syndrome is the use of Hormone Replacement Therapy (HRT).
 

Many trials on the use of hormone replacement therapy (HRT) during the past one decade have provided contradictory results on its risks and benefits in post-menopausal women that has consequently put the medical community in quandary in decision making about use of HRT. The use of HRT declined globally following publication of the first data from the Women’s Health Initiative (WHI) trial in 2002, with the revelation that there was an increased risk of breast cancer and coronary heart disease (CHD) in postmenopausal women taking HRT. Following this, Heart and Estrogen/Progestin Replacement Study & its follow-up (HERS I & II), WHI Memory Study (WHIMS), Women’s international study of long duration oestrogen after menopause (WISDOM) and the Million Women Study (MWS) published results that were consistent with the findings of the WHI study. This reduced enthusiasm for HRT use, and many health professionals and patients considered the use of such hormones as ‘unsafe’, leading to reduction in HRT prescribing.

However, recent publications from the International Menopause Society indicate that HRT is the first-line and most effective treatment for menopausal symptoms.  Moreover when the full results of the WHI trial were subsequently published it appeared that HRT may confer benefit for CHD prevention below age 60. The consensus statements from the British Menopause Society and the International Menopause Society (IMS) published in 2008 also supported this opinion. These revelations renew interest in realms of HRT use. This paper analyzes the current status of HRT use in post-menopausal women vis-à-vis effects of combination versus unopposed HRT on, osteoporosis, breast and CHD, endometrial cancer induction, venous thromboembolic disease, on lipids and lipoproteins, neuroprotection and cognitive function, in post-menopausal women.

 

The differences in age at initiation and the duration of HRT are key points. The intention dose and regimen of HRT need to be individualized based on the principle of choosing the lowest appropriate dose in relation to the severity of the symptoms and the time and age. HRT appears to decrease coronary artery disease in younger women, near menopause yet, in older women, HRT increases risks of coronary event.