Hormone replacement therapy is an effective and accepted drug therapy for menopausal symptoms. The results of known studies presented below indicate that an individual risk-benefit analysis must always be performed by your physician – together with the patient: On July 17, 2002, the American Medical Journal published a study on the effects of long-term treatment of postmenopausal women with estrogen/progestin preparations. This study – called the “Women’s Health Initiative” (WHI) – had to be stopped prematurely because the interim evaluation of the data collected up to that point already showed a significantly increased rate for breast cancer, coronary heart disease (CHD), apoplexy (stroke) and thrombosis/lung embolism compared to the placebo group. These results were confirmed by the British “One Million Women Study” with regard to breast cancer risk. The risk of disease and death was even higher than in the American study, according to an evaluation in the Lancet. However, the Women`s Health Initiative (WHI) study and the One Million Women Study also showed that hormone replacement therapy led to a reduction in femoral neck fractures-10 fractures versus 15 fractures in the untreated group. The U. S. Preventive Services Task Force concluded in 2005 that despite the positive effects of appropriate hormone replacement therapy on bone density, with a reduced risk of fracture and a reduced risk of developing colon cancer, the risks outweigh the benefits, such as increased risk of breast cancer as well as venous thromboembolism, apoplexy (stroke), cholecystitis, dementia, and possibly coronary heart disease (CHD).
However, publications in prestigious journals such as Science suggest that individualized hormone therapy still has its importance. In the so-called “early menopause“, which already occurs at the age of less than 45 years, e.g. due to a bilateral ovariectomy (removal of the ovaries), hormone replacement therapy can be useful. This is also the conclusion of a guideline of the “European Menopause and Andropause Society” (EMAS).
In the meantime, the authors of the WHI study in the “New England Journal of Medicine” have corrected the validity of their own study: In women between 50 and 59 years of age, in addition to the lasting elimination of hormone deficiency symptoms, a lower number of bone fractures, a reduction in the rate of diabetes and deaths in general can be observed.
Conclusion Hormone replacement therapy should be used, for example, in cases of severe menopausal symptoms or “early menopause“. As a general rule, hormone replacement therapy should be used only as long as necessary and at the lowest possible dose.
Benefits
Hormone replacement therapy is a recognized and effective treatment for menopausal symptoms. Many women can be effectively helped during this phase of life. Information on consensus recommendations of the German Society of Gynecology and Obstetrics on hormone replacement therapy (HRT) for menopause and postmenopause is available at www.dggg.de .
