Hormone-replacement therapy benefits

Denke MA. Hormone replacement therapy benefit and safety issues. Curr Opin Lipidol 1996 7(6) 369-73. 

The administration of drugs to ease disease and chronic, severe pain or to provide benefits such as hormone replacement therapy is difficult because drugs taken orally may lose much of their potency in the harsh conditions of the digestive system. In addition, they are distributed throughout the entire body, not just where they are needed, and side effects can be significant. Recently, however, techniques have been developed to deliver drugs gradually over time, to the exact location in the body where they are needed, and even at the time when they are needed. 

Explain the risks and benefits associated with hormone-replacement therapy. 

Long-term use of hormone-replacement therapy and concurrent use of progestins appear to contribute to breast cancer risk.7 The use of postmenopausal estrogen-replacement therapy in women with a history of breast cancer generally is considered contraindicated. However, most experts believe that the safety and benefits of low-dose oral contraceptives currently outweigh the potential risks and that changes in the prescribing practice for the use of oral contraceptives are not warranted. Oral contraceptives are known to reduce the risk of ovarian cancer by about 40% and the risk of endometrial cancer by about 60%. 

Hormone therapy has proven highly effective in controlling the menopausal syndrome, especially severe hot flushes (MacLennan et al. 2004), even at doses significantly lower than those used until now (Speroff et al. 2000 Utian et al. 2001). Women s Health Initiative studies found that hormone replacement therapy, when administered as a primary prevention intervention for CVD in older women, increases the risk of heart disease and breast cancer. Even if a protective effect on fracture and colon cancer was observed, the risk-benefit ratio led to a recommendation of this treatment only for the short-term relief of menopausal symptoms (Rossouw et al. 2002 Anderson et al. 2004). The role of early administration of ovarian hormones to young postmenopausal women in the prevention of cardiovascular disease or late dementia remains... 

Estrogens are most commonly used as a component of combination contraceptives or as hormone replacement therapy in postmenopausal women. Benefits in postmenopausal women include relief of moderate to severe vasomotor symptoms and decreased risk of osteoporosis. Hormone replacement therapy also may be used in vaginal and vulvar atrophy and in hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure. Less commonly, select breast or prostate cancer... 

Currently recommended that use of hormone replacement therapy be limited to treating symptomatic women, preferably for 5 yr or less. Risk felt to outweigh benefit in asymptomatic women using only for prophylaxis of other conditions... 

The Million Women Study in the UK (18) has been criticized on various grounds by some proponents of hormone replacement therapy, notably because in their view the number of deaths from breast cancer was too small and the follow-up too short to justify the belief that HRT increases the risk of death from breast cancer discrepancies between this and other studies have also been stressed (19). The interpretation of the study in the editorial that accompanied it has also been criticized as being unduly pessimistic. However, the fact remains that the study is not the only source of serious doubts about the benefit to harm balance of hormone replacement therapy. 

The evidence of adverse effects emerging from randomized trials in and around 2002 has resulted in a dramatic fall in the use of hormone replacement therapy, the use of some formulations falling by two-thirds (21). Continuing debate on the benefit to harm balance of hormonal therapy at the time of the menopause or subsequently has in the recent past hardly yielded new conclusions (22). 

Barrett-Connor E, Stuenkel CA. Hormone replacement therapy (HRT)—risks and benefits. Int J Epidemiol 2001 30(3) 423-6. 

With increasing concern over the long-term safety of hormone replacement therapy, the benefit to harm balance has to be continually reassessed, and conclusions as to its prophylactic or therapeutic value need to be adjusted as experience accumulates. Not all the promises held out for the benefits of this therapy have been confirmed. For example, while estrogens prevent peripheral bone loss they do not prevent vertebral fractures (6) and in a 2-year placebo-controlled, crossover study in 34 healthy postmenopausal women, treatment with transder-mal estrogen alone (Menorest 50 micrograms/day) did not improve lipid profiles or any indices of arterial function (7). 

Options for treatment include hormone replacement therapy (HRT), bisphosphonates, calcitriol, calcitonin, raloxifene, strontium ranelate, and teriparatide. Hormone replacement therapy is generally indicated for women who are under 50 years and are experiencing a premature menopause. Symptomatic menopausal women may opt to use HRT also, as the benefits outweigh the risks for up to 5 years treatment. They may choose an alternative treatment for osteoporosis if preferred. Hormone replacement therapy is not recommended for first line treatment for long-term prevention of osteoporosis in women over 50 years of age. 

MAGNESIUM HORMONE REPLACEMENT THERAPY May cause magnesium depletion Mg levels tend to l during menopause. Risk-benefit ratios need to be considered on an individual basis as there are suggestions that magnesium can counteract the alleged T risk of heart attacks and strokes in patients on hormone replacement therapy Be aware... 

With increasing concern over the long-term safety of hormone replacement therapy, the benefit to harm balance has... 

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