Abstract
For more than two decades, HRT was the treatment of choice for the prevention of postmenopausal osteoporosis. HRT is known to be efficacious in preventing postmenopausal bone loss and fractures that occur as a result of postmenopausal estrogen deficiency. Nevertheless, with the publication of the results from the Women’s Health Initiative (WHI) in 2002, the world’s largest randomized placebo-controlled study of HRT in seemingly healthy, yet elderly, women, the political climate surrounding HRT use in postmenopausal women in general changed suddenly and dramatically. The WHI results indicated a lack of prevention of cardiovascular disease (CVD) in this population, and reported a small but significantly increased risk of CVD among women in the HRT arm, which was in clear contrast to the results from the abundant animal and large epidemiological studies. The WHI study has been criticized regarding the study population and HRT regimen used. Very recent reanalysis of the WHI data suggested that HRT in early menopause is associated with protection from CVD, which, however, is gradually reduced as the years since menopause increase, suggesting that age or years since menopause play important roles in the prevention of CVD by HRT, as corroborated by other data. In this review, we describe the effects of HRT on bone and on other target organs based on the current evidence. Currently available alternatives to HRT are briefly discussed. We also review the WHI results that impacted the medical community with regard to HRT prescription practice.
Financial disclosure
The authors have no relevant financial interests related to this manuscript, including employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.