Individualizing Hormone Therapy to Minimize Risk

Accurate Assessment of Risks and Benefits

Donna Shoupe

Disclosures

Women's Health. 2011;7(4):475-485. 

In This Article

Abstract and Introduction

Abstract

Contrary to the exaggerated risks associated with HRT that developed after the initial press reports held by the Women's Health Initiative (WHI) writing group, the recent approach to hormone therapy is more balanced and evidence based. A review of over 40 years of scientific studies demonstrates that estrogen is a medication that can decrease mortality, cardiovascular disease, osteoporosis fracture, urogenital atrophy and dementia. When timing of administration, dose of therapy and route of administration are considered, estrogen is associated with low risks and substantial benefits. The decision of whether or not to take HRT for either short symptom relief or for long-term therapy, should be based on an accurate risk–benefit analysis. Adjusting the dose of therapy and considering a transdermal approach, particularly in high-risk patients, are important considerations.

Introduction

After the release of the Women's Health Initiative (WHI) press reports in the USA in 2002, the use of HRT among women around the world declined abruptly. Since then, a better understanding of risks and benefits of hormone therapy has clarified the WHI findings and led to a more balanced approach to counseling. One of the most important findings of the WHI is that the age of initiation of therapy has profound effects on the risk and benefit profile. Currently there are very important ongoing studies designed to further characterize the timing hypothesis that simply says that timing of initiation is critical to understanding the therapeutic actions of estrogen.[1,101] These data are not expected to be known for several years. However, even without these results, careful review of over 40 years of studies demonstrates several important points. Estrogen is a medication that can decrease mortality, decrease cardiovascular disease, decrease osteoporosis fracture, urogenital atrophy and dementia. Strategies to minimize risk include initiation of therapy within 10 years of menopause or under 60 years of age, using low-dose estrogen, adding a low-dose progestin in women with a uterus, and use of transdermal therapy in women with risk factors for cardiovascular disease.

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