- The results of the WHI study confirm what is already known about the long-term risks of HRT, including breast cancer and venous thromboembolism.
- HRT has not been proven to be beneficial in primary and secondary prevention of coronary heart disease in fact may result in a small increased rate of CHD.
- ACOG continues to recommend that decisions regarding HRT therapy must be made between the woman and her ohysician on an individual basis.
- HRT is the most effective treatment of menopausal symptoms.
- For patients with osteoporosis, other preventive therapies such as bisphosphonates and SERM are available. However, for women at risk of osteoporosis who also have vasomotor menopausal symptoms, HRT can be of benefit. (ACOG. Aug. 2002)
- Continuous combined HRT was associated with an increased breast cancer risk if used for four years or more. However, this increased risk dissipates quickly once use is discontinued. (NICHD Study Nov. 29. 2002. WHI July 2002)
- Inspite of an increased risk of breast cancer diagnosis, the motality from breast cancer is unchanged. (WHI July 2002)
- Unopposed estrogen therapy should not be used in women with a uterus because of an increased risk of endometrial cancer.
- A combined continuous regimens offer better protection of the endometrium than sequential regimens. (N.Z guideline May 2001)
- There is no conclusive evidence that combined regimen HRT either increases or decreases the risk of developing ovarian cancer.
- Researchers from the National Cancer Institute (NCI) have found the women in a large study more than 44000 women who used estrogen replacement therapy after menopause were at increased risk for ovarian cancer.
- Unlike earlier observational studies that suggested the possibility of some protection against heart disease, recent studies showed a small but significant increased risk of non-fatal heart attacks.
- HRT & Cardiac risk: HERS I 1998 (The Heart and Estrogen Replacement Study) -> HERS II, published in the July 2002 JAMA.
- HERS II: confirm increased risk of coronary events in the early years of treatment.
- HERS II: increased in thromboembolic events in the HRT group compared with placebo mainly seen in the first year of use.
- HRT is contraindicated for secondary prevention of further coronary disease because of lack of documented efficacy and a possible early excess mortality.
- The Women's Health Initiative (WHI) Study (July 2002 JAMA)
- The benefit were a reduction in colorectal cancer (emerged after 3 years)
- A reduction of hip fracture.