Prescribing postmenopausal hormone therapy to women in their 50s in the post-Women's Health Initiative era.

摘要

Originally used primarily for the treatment of menopausal symptoms, prescriptions for menopausal hormone therapy (MHT) rose sharply from the late 1980s onwards following the publication of several epidemiologic studies showing that use of MHT was associated with a lower risk of osteoporosis and coronary heart disease. These studies also showed an increased risk of venous thrombo-embolism, and with prolonged use also of breast cancer, in addition to a previously demonstrated risk of endometrial cancer. Whereas the increased risk of endometrial cancer could be abolished by the addition of a progestin to estrogen, breast cancer risk appeared to be further increased by progestin. Nonetheless, towards the turn of the new century the consensus opinion of most professional societies was that the benefits of MHT outweighed the risks, and MHT was widely recommended for all post-menopausal women and in particular for women at high risk of coronary heart disease. The perceived favorable risk-benefit ratio depended heavily on the assumption that MHT would reduce the risk of coronary heart disease, a major affliction of women in the postmenopausal and older age groups.