Conclusion

Schiff: In this presentation we concentrated on the short-term benefits and risks of hormone replacement therapy. We stressed the concept that the patient and the health-care provider should be partners in the decision on whether or not to take HRT. The short-term benefits we discussed included alleviation of hot flushes and vaginal dryness in the early menopausal years.

As for longer-term benefits, since it’s clear that estrogen helps to prevent osteoporosis, we focused on the understanding of estrogen’s relationship with heart health, which is still evolving. In the past, we were fairly confident that estrogen was protective, but results of trials for secondary prevention of heart disease have been disappointing. We are awaiting the conclusion of the Women’s Health Initiative in 2005 to learn whether estrogen will continue to have an important role in primary prevention of heart disease, as many observational studies have suggested.

With respect to endometrial cancer, we have learned that adding a progestin to the hormone regimen eradicates the risk but induces vaginal bleeding. We agreed that giving progestin and estrogen in a continuous combined fashion eliminates this bleeding in most cases. We also agreed that some combinations of estrogen and progestin offer superior results in achieving amenorrhea. Head-to-head trials are warranted, however, to confirm these differences.

Once the health-care provider and the patient decide hormones are indicated, continued use is needed for optimal benefits. We concluded that the best way to assure continuance is to prescribe a regimen that alleviates symptoms while minimizing side effects such as breakthrough bleeding.