Hormone Replacement Therapy: The Debate over the Risks and Benefits To Women, from Breast Cancer To Quality of Life

The use of hormone replacement therapy, unopposed estrogen or combined estrogen plus progestin, for postmenopausal women has been debated for many years. It has been used for relief from menopausal symptoms and for protective measures from chronic conditions, such as cardiovascular disease and osteoporosis. There have been observational studies and randomized clinical trials undertaken to determine the benefits and risks of these therapies. There are no definite answers among the trials and there are some discrepancies. The major findings, however, have been an increase in breast and endometrial or ovarian cancer, an increase in coronary heart disease, stroke and thromboembolism, a decrease in colorectal cancer, a decrease in bone fractures and an improvement in menopausal symptoms. The current, overall recommendation to women is not to use hormone replacement therapy as a long-term protective measure, but after individual consideration, it may be appropriate on a short-term basis for relief of menopausal symptoms.