Key content
Hormone replacement therapy (HRT) is the most effective treatment for symptoms of estrogen deficiency. When HRT is individually tailored women gain maximum advantages and the
risks are minimised.
Several types and regimens of HRT and different routes of delivery exist. Results from studies using only one type and route may not therefore apply to all users.
The use of HRT is an individual decision, which a woman can only make once she has been given correct information and advice from healthcare professionals.
HRT should be recommended in women with premature ovarian
insufficiency with advice to continue until the average age of the menopause at 51.4 years.
Learning objectives
To review the current research and the evidence on the use of HRT in women.
Application of the evidence in relation to the management of the symptomatic menopausal woman.
To promote confidence in prescribing HRT in most symptomatic women.
To have a general overview of prescribing in women with relative contraindications.
Ethical issues
The use of HRT is a patient informed choice.
Where evidence is limited and quality of life a priority, then a multidisciplinary approach may be necessary and informed written consent documented.
Keywords: breast cancer / cardiovascular disease / hormone
replacement therapy / menopause / quality of life /thromboembolism
Introduction
Effect of HRT on cardiovascular events in recently postmenopausal women
Premature ovarian insufficiency
Conditions that are not contraindications to HRT
Asthma
Past history of benign breast disease
Previous abnormal smears/cervical cancer
Contact lens wearers
Depression
Diabetes
Controlled blood pressure
Hyperlipidaemia
Melanoma
Multiple sclerosis
Obesity
Renal failure
Sickle cell anaemia
Smoking
Thyroid disease
Osteoporosis prevention in young women with premature ovarian
insufficiency
Relative contraindications that should be referred for specialist
advice
Existing cardiac disease
Active liver disease
Systematic lupus erythematosus
Previous breast cancer
Previous ovarian/endometrial cancer
Undiagnosed vaginal bleeding
Previous personal/family history of venous thromboembolism