Abstract
Over the last 70 years, oestrogen therapy for the management of menopausal symptoms has undergone a metamorphosis from perceived cardiovascular protection to perceived cardiovascular risk. The former perception is based on the convincing evidence from the Nurses’ Health Study cohorts and the epidemiological data surrounding early menopause. The latter, and later, perception is based on the disquieting results from two randomised controlled studies, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women’s Health Initiative study (WHI). The reality is probably more nuanced than the conclusions presented by any of these studies. When face to face with a patient, the clinician must negotiate the appropriate decision pathway around the interaction between cardiovascular risk, cardiovascular disease, menopause, and oestrogen +/− progestogen–containing hormone therapy.
Reference33 articles.
1. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial.;JAMA: The Journal of the American Medical Association,2004
2. Australian Bureau of Statistics (2016) Causes of death, Australia, 2015. (Australian Bureau of Statistics)
3. Australian Institute of Health and Welfare (2023) Australian burden of disease report 2023. (Australian Institute of Health and Welfare)
4. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy.;Climacteric,2016
5. Hormone replacement therapy after breast cancer: it is time.;Cancer Journal,2022