As a family General practitioner consulting daily I am often asked by well women going through the menopause about Hormone Replacement Therapy. I start my counseling session with “Well… menopause is a normal part of life and there is a place for hormone therapy but ….”
The correct status is that the preventative health bodies recommend against the routine use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women.
The rationale behind this is that there is good evidence that the use of combined estrogen and progestin results in both benefits and harms. Benefits include reduced risk for fracture (good evidence) and colorectal cancer (fair evidence). Combined estrogen and progestin has no beneficial effect on coronary heart disease and may even pose an increased risk (good evidence). Other harms include increased risk for breast cancer (good evidence), venous thromboembolism (good evidence), stroke (fair evidence), cholecystitis (fair evidence), dementia (fair evidence), and lower global cognitive function (fair evidence).
Because of insufficient evidence the preventative health groups could not assess the effects of combined estrogen and progestin on the incidence of ovarian cancer, mortality from breast cancer or coronary heart disease, or all-cause mortality. The conclusion is that the harmful effects of combined estrogen and progestin are likely to exceed the chronic disease prevention benefits in most women.
Please be aware that this discussion is for normal lifecyle menopause without severe symptoms. Surgical or early menopause, debilitating symptoms and all the health factors that make a person an individual mean that any decision to consider hormone therapy needs to be made in careful consultation with your personal Doctor.
