Evidence-based hormone replacement therapy for the well woman at menopause

Placebo-controlled studies have shown that oestrogen is effective for post-menopausal vasomotor and urogenital symptoms. Unopposed oestrogen may cause endometrial cancer, and women with a uterus should receive oestrogen combined with a progestogen. Symptomatic women can use hormone replacement therapy (HRT) for up to 3-5 years, but those wanting longer-term treatment must be fully counselled about the risks. Regarding asymptomatic women, placebo-controlled studies have shown that HRT reduces post-menopausal bone loss and fracture rates, but the protective effect is lost after treatment is stopped. Randomised studies have shown that HRT increases the risk of stroke and venous thromboembolism. All forms of HRT, but particularly combined HRT, increase the risk of breast cancer: the excess risk increases with duration of use and disappears 5 years after stopping HRT. Randomised trials have shown no effect of HRT on cardiovascular disease but were stopped early because of adverse effects. Asymptomatic women should not use HRT for disease prevention.