Evaluation of the benefits and risks of hormone replacement therapy

GKH Au
Department of Clinical Oncology, Queen Mary Hospital, Pokfulam, Hong Kong

OBJECTIVE. To review recent data on outcome of hormone replacement therapy in postmenopausal women.

DATA SOURCES. Medline search of the literature and local data.

STUDY SELECTION. Data on efficacy of hormone replacement and its unwanted side effects were examined.

DATA EXTRACTION. Statistical data were extracted from published studies and meta-analyses.

DATA SYNTHESIS. Statistical data came mainly from observational studies and not from randomised trials, and were therefore subject to bias. Overall, it would appear reasonable to say that risks for breast and endometrial cancers, as well as thromboembolism, were increased, while the risks for cardiovascular death and osteoporotic fractures were reduced by hormone replacement therapy. Locally, for every 100,000 women treated for 3 to 5 years, there may be 22 fewer cardiac deaths, 10 to 20 more cases of breast cancer, seven more cases of endometrial cancer, 10 more cases of thromboembolic disease, and slightly fewer cases of osteoporotic fracture.

CONCLUSION. Reported data and risk estimates have been derived predominantly from data on white Caucasian women. Their baseline risk may be different from those of Chinese women. A low baseline risk in the local population may influence treatment results, and large-scale randomised trials are needed to give a definitive answer.

Hong Kong Med J 2000;6:381-9

Key words: Estrogen replacement therapy; Estrogens/conjugated; Menopause/drug effects; Risk factors