Hormone replacement therapy
Postmenopausal hormonal therapy has been used to manage climacteric symptoms since the 1950s. Several large observational studies suggested that the use of HRT may also have a role in the prevention of chronic conditions in the postmenopausal woman. In a Department of Health survey performed in 1998, 38% of women in England aged 4554 years had used HRT. However over the past few years there has been a marked fall in prescribing rates due to the publication of several studies concerning the risks and benefits of HRT. There became concerns about the safety of HRT and this lead to confusion and uncertainties amongst health professionals and postmenopausal women. The use of HRT changed markedly and recommendations suggested short term use for moderate to severe symptoms in a low a dose as possible in women with no contra-indications. However HRT is the best treatment we have at present to treat symptoms of the menopause including hot flushes, night sweats and vaginal dryness.
There has been much criticism and further analysis of studies. It now appears that HRT used in the early postmenopause offers some benefits and the risks are low if hormone therapy is initiated within a few years of the menopause. Long term use of hormone replacement therapy to prevent chronic disease is not recommended.
It is important to assess the merits of HRT use on an individual basis. The degree of symptoms, the risk factors, benefits and type of HRT should be fully discussed. We already know that not all HRT preparations are the same. Observational studies continue to show reduced mortality in younger women taking HRT. We should offer individual advice and not deny treatment to women who may benefit. Women with premature ovarian failure should be offered HRT until the time of the natural menopause.