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Abstract
Hormone replacement therapy (HRT) has been prescribed to relieve typical oestrogen
deficiency symptoms, conserve postmenopausal bone and thereby reduce the risk of osteoporotic
fracture, and also to reduce the risk of certain arterial diseases such as ischaemic
heart disease (IHD).
Numerous placebo-controlled studies have confirmed that oestrogens reduce the frequency
and severity of flushes and sweats, and also improve vaginal dryness. Although not
consistent, some data report an improvement in psychological symptoms such as poor
memory and concentration. At appropriate daily dose, oestrogens reduce postmenopausal
bone loss in both spine and hip; data on fracture efficacy from controlled studies
at both of these sites are lacking, but observational data report reductions in fracture
risk.
The effects of HRT in women with risk factors for IHD are controversial, with some
studies reporting benefits but others not. The majority of the observational data
in apparently fit and healthy younger women report an approximate 50% reduction in
IHD with use of HRT.
The major long-term concern of use of HRT is risk of breast cancer. There is an approximate
threefold excess risk of venous thrombosis with all forms of therapy and an approximate
60% excess risk of gallstones with oral therapy. Other side effects tend to be short-lived
and include breast tenderness (due to the oestrogen) and a PMT-like complex (due to
the progestogen). Numerous studies report no significant effect on weight, systolic
or diastolic blood pressure.