Hormone therapy after menopause: Advantages and Disadvantages

Document Type : Review Article

Authors

1 Professor, Department of Obstetrics and Gynecology, Women's Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 PhD of Reproductive Health, School of Medicine, Islamic Azad University of Tonekabon, Tonekabon, Iran.

3 PhD of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Hormone therapy is widely used to control the menopause symptoms, prevention and treatment of cardiovascular disease, osteoporosis and dementia in old women. This study was performed with aim to identify the long-term effects of hormone therapy on menopausal problems.
Methods: This study was performed as a review of 25 articles related to hormone therapy after menopause between 1999 and 2010.  Searching was performed in databases including ISI web of Science, Up to date, and Scopus using keywords of menopause, hormone therapy, complications of hormone therapy, estrogen and progesterone. Inclusion criteria included the insertion of search terms in the title or keywords of the article. Articles with incomplete data and articles which only their abstracts are available were excluded.
Results: In relatively healthy women, continuous combined hormone therapy significantly increases the risk of venous thromboembolism or coronary events, stroke, breast cancer and gallbladder disease. Long-term hormone therapy with estrogen alone significantly increases the risk of stroke and gallbladder disease. In general, the only benefits of hormone therapy are reducing the incidence of fractures and colon cancer with long-term use.
Conclusions: Hormone therapy is not an indication for routine management of chronic disease. There is a need for more evidence on the safety of hormone therapy to control the menopausal symptoms. It is believed that short-term use of hormones is relatively safe for healthy younger women.

Keywords

References

  1. Promoting women’s health at midlife and beyond. North American Menopause Society. Available at: URL: www.menopause.org; 2004.
  2. Martin KA, Barbieri RL. Postmenopausal hormone therapy: Benefits and risks. Nature Endocrinology. Available at: URL: http://www.uptodate.com; 2013.
  3. Greendale GA, Lee NP, Arriola ER. The menopause. Lancet 1999; 353(9152):571–80.
  4. Hormone Replacement Therapy. Australian Government. National Health and Medical Research Council. Available at: URL: http://www.dcita.gov.au/cca; 2005.
  5. Kronenberg F. Hot flashes: phenomenology, quality of life and search for treatment options. Exp Gerontol 1994; 29(3-4):319–36.
  6. Martin KA, Barbieri RL. Preparations for postmenopausal hormone therapy. Up To Date. Available at: URL: http://www.uptodate.com; 2010.
  7. Barbieri RL. Patient information: Postmenopausal hormone therapy. Up To Date. Available at: URL: http://www.uptodate.com; 2010.
  8. Whayne TF Jr, Mukherjee D. Women, the menopause, hormone replacement therapy and coronary heart disease. Curr Opin in Cardiol 2015; 30(4):432-8.
  9. Anderson GL, Limacher M, Assaf AR, Bassford T, Baresford SA, Black H, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004; 291(14):1701-12.
  10. Kaplan NM, Burton DR. Effect of oral contraceptives and postmenopausal hormone therapy on blood pressure. Up To Date. Available at: URL: http://www.uptodate.com; 2010.
  11. Wassertheil-Smoller S, Hendrix SL, Limacher M, Heiss G, Kooperberg C, Baird A, et al. Effect of estrogen plus progestin on stroke in postmenopausal women: the Women's Health Initiative: a randomized trial. JAMA 2003; 289(20):2673-84.
  12. Davey DA. HRT: some unresolved clinical issues in breast cancer, endometrial cancer and premature ovarian insufficiency. Womens Health (Lond Engl) 2013; 9(1):59-67.
  13. Chen WY. Menopausal hormone therapy and the risk of breast cancer. Up To Date. Available at: URL: http://www.uptodate.com; 2010.
  14. Cauley JA, Robbins J, Chen Z, Cummings SR, Jackson RD, LaCroix AZ, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial. JAMA 2003; 290(13):1729-38.
  15. Rosen HN, Drezner MK. Postmenopausal hormone therapy in the prevention and treatment of osteoporosis. Up To Date. Available at: URL: http://www.uptodate.com; 2010.
  16. Chlebowski RT, Wactawski-Wende J, Ritenbaugh C. Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med 2004; 350(23):991-9.
  17. Anderson GL, Judd HL, Kaunitz AM, Barad DH, Beresford SA, Pettinger M, et al. Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial. JAMA 2003; 290(13):1739-48.
  18. Rapp SR, Espeland MA, Shumaker SA, Henderson VW, Brunner RL, Manson JE, et al. Effect of estrogen plus progestin on global cognitive function in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. JAMA 2003; 289(20):2663-72.
  19. Shumaker SA, Legault C, Rapp SR, Thal L, Wallace RB, Ockene JK, et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. JAMA 2003; 289(20):2651-62.
  20. Cirillo DJ, Wallace RB, Rodabough RJ, Greenland P, LaCroix AZ, Limacher MC, et al. Effect of estrogen therapy on gallbladder disease. JAMA 2005; 293(3):330-9.
  21. Col NF, Weber G, Stiggelbout A, Chuo J, D’Agostino R, Corso P. Short-term menopausal hormone therapy for symptom relief: an updated decision model. Arch Intern Med 2004; 164(15):1634-40.
  22. Hays J, Ockene JK, Brunner RL, Kotchen JM, Manson JE, Patterson RE, et al. Effects of estrogen plus progestin on health-related quality of life. N Engl J Med 2003; 348(19):1839-54.
  23. Strom BL, Schinnar R, Weber AL, Bunin G, Berlin JA, Baumgarten M, et al. Case-control study of postmenopausal hormone replacement therapy and endometrial cancer. Am J Epidemiol 2006; 164(8):775-86.
  24. Weiderpass E, Adami HO, Baron JA, Magnusson C, Bergstrom R, Lindgren A, et al. Risk of endometrial cancer following estrogen replacement with and without progestins. J Natl Cancer Inst 1999; 91(13):1131-7.
  25. Lacey JV Jr, Leitzmann MF, Chang SC, Mouw T, Hollenback AR, Schatzkin A, et al. Endometrial cancer and menopausal hormone therapy in the National Institutes of Health-AARP Diet and Health Study cohort. Cancer 2007; 109(7):1303-11.
  26. Kim MY, Choi SD, Ryu A. Is complementary and alternative therapy effective for women in the climacteric period? J Menopausal Med 2015; 21(1):28-35.
  27. Wang PH, Horng HC, Cheng MH, Chao HT, Chao KC. Standard and low-dose hormone therapy for postmenopausal women--focus on the breast. Taiwan J Obstet Gynecol 2007; 46(2):127-34.
  28. Rozenberg S, Vandromme J, Antoine C. [Menopausal hormone treatment in 2011]. Rev Med Brux 2011; 32(4):239-42.
  29. Lindsay R, Gallagher JC, Kleerekoper M, Pickar JH. Effect of lower doses of conjugated equine estrogens with and without medroxyprogesterone acetate on bone in early postmenopausal women. JAMA 2002; 287(20):2668-76.
  30. Sturdee DW. Are progestins really necessary as part of a combined HRT regimen? Climacteric 2013; 16(Suppl 1):79-84.

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