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The benefits of oestrogen following menopause: why hormone replacement therapy should be offered to postmenopausal women
Introduction
—The Women’s Health Initiative
—Oestrogen plus progestogen10
—Oestrogen only15
—The Million Women Study16
—Hormone cessation and a reduction in breast cancer
—When does breast cancer begin?
—Hormones and the cardiovascular system
—Hormones and dementia
—Hormones and osteoporosis
—Hormones and longevity
—Hormones and quality of life
—Competing interests
—Author details
—References
Recently, two major epidemiological studies found that hormone replacement therapy (HRT) in postmenopausal women increased the risk of breast cancer. One of the studies also found that HRT increased the risk of cardiovascular disease and thrombosis. As a consequence, women were advised to cease this therapy.
However, detailed analysis of these studies suggests that the conclusions may be erroneous. Other studies suggest that the timing of initiation of HRT for healthy women is critical to achieving a beneficial outcome.
When begun within 5 years of menopause in healthy women, oestrogen-based HRT results in far greater benefits than adverse outcomes.
There is substantial objective evidence that the benefits of HRT include:
Reduced distressing symptoms of menopause.
Reduced risk of osteoporotic fractures, dementia and colorectal cancer.
Improved wellbeing, quality of life; improved vaginal epithelium, sexual enjoyment and bladder capacity.
Improved cardiovascular system, with reduced myocardial ischaemia and cardiovascular-related death.
Increased longevity.
The adverse effects of HRT include:
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©The Medical Journal of Australia 2009 www.mja.com.au PRINT ISSN: 0025-729X ONLINE ISSN: 1326-5377