Short-term hormone replacement therapy (HRT) in postmenopausal women is effective for the treatment of estrogen deficiency symptoms such as vasomotor flushes and vaginal dryness. Most practitioners would agree that short-term use (up to 3 years) of HRT (combined estrogen and progestin for those with a uterus) is not associated with significant health risks. Specifically, no study has demonstrated an increased risk of breast cancer with short-term use. On the other hand, long-term use of HRT to prevent osteoporosis and coronary heart disease might be associated with possible risks, in particular breast cancer. At this time, it remains unclear which postmenopausal women are candidates for long-term HRT. Specific areas of controversy include (1) the role of estrogen in primary versus secondary prevention of coronary heart disease, (2) the impact of estrogens and progestins on breast cancer risk, and (3) the risk of venous thromboembolic events with postmenopausal estrogen use.
Reproductive Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Correspondence to Kathryn A. Martin, MD, Reproductive Endocrine Unit, BHX-5, Massachusetts General Hospital, Fruit St., Boston, MA 02114, USA; e-mail: email@example.com