Hormone replacement therapy – Current recommendations. (May 2022) - Vigneswaran, Kugajeevan
Abstract: Menopause is a major life event that can affect women in several ways. Its onset marks the end of the reproductive life cycle, and its impact can be both short and long term. Menopause is often a gradual process, preceded by a transitional period known as perimenopause. The average age of menopause in the UK is 51. The clinical manifestations of menopause result from the eventual exhaustion of oocytes within the ovaries. This leads to a chronic hypo-estrogenic state, which in the short term causes menopausal symptoms and over a long term, has an impact on bone and cardiovascular health. There has been a steep drop in the prescription of hormone replacement therapy (HRT) following the publication of the Women's Health Initiative Study and the Million Women Study. It is currently estimated that approximately a million women in the UK are taking HRT for control of their menopausal symptoms. This review summarises the current recommendations for HRT use in menopausal women. The benefits of HRT in improving the symptoms of menopause are discussed as well as the potential role of HRT in managing long-term sequelae is covered. Evidence pertaining to the potential risks associated with HRT is also be reviewed. Highlights: The clinical manifestations of the menopause are caused by a chronic hypoestrogenic state, which in short term causes menopausal symptoms, and over a long term can have a detrimental impact on bone and cardiovascular health. The available evidence would suggest that HRT can be offered to otherwise healthy women during the perimenopause or early postmenopause with moderate to severe symptoms, as the benefits outweigh the risks in this age group. The decision whether to take HRT, the dose, and duration of its use, however, should be made on an individualised basis after discussing the benefits and risks with each patient, and arbitrary limits should not be placed on the duration of usage. Appropriate HRT use commenced within the 'critical therapeutic window' may infer additional protective cardiovascular effects.