safety profile of HRT
Use of HRT for ≤5 years is safe and effective in a majority of symptomatic women.
The Women’s Health Initiative Study and the Nurses’ Health Study has estimated benefits and risks of oral HRT in postmenopausal women aged 50-59 years, or <10 years after menopause and according to these studies
- majority of HRT related adverse effects increases with age
- risks will differ with age and current health status (1)
The main risks which should be considered when on HRT are:
- thromboembolic disease (venous thromboembolism and pulmonary embolism)
- the risk is increased with oral HRT (in both combined and oestrogen only pills)
- the type, dose and delivery system may also affect the risk
- a recent systematic review found out that the risk of venous thromboembolism is incrased in oral HRT(but not transdermal)
- in another large prospective observational study, the incidence of venous thromboembolism in low risk populations was not increased with low dose (≤1.5 mg oral, or ≤50 μg transdermal) oestradiol
- hence a transdermal preparation and a reduced oestrogen dose is favored in women with increased risk of thromboembolic disease (1)
- stroke
- HRT increases the risk of stroke
- HRT or tibolone should be avoided in women at high risk of stroke
- cardiovascular disease
- although the relationship between HRT and cardiovascular disease is questionable, the timing and duration of HRT, as well as pre-existing cardiovascular disease seems to have an effect on the outcome `
- breast cancer
- the risk of breast cancer diagnosis or breast cancer mortality is greater with combined HRT than with oestrogen alone
- the risk with tibolone is not established (but large observational studies have shown an increased risk)
- endometrial cancer
- the risk is not increased with combined continuous HRT (when adequate duration and dose of progestogen are used) but risk may be increased with sequential HRT
- risk of endometrial hyperplasia or cancer is not present in Tibolone users
- gallbladder disease
- HRT increases the risk of cholecystitis but can be reduced by using transdermal rather than oral HRT (1)
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