The objective of this guideline is to provide a summary of the evidence of the benefits and risks of, and contraindications to, the use of Hormone Replacement Therapies (HRT). 

 

KEY MESSAGES

 

HRT is not recommended for routine use in the menopause.

 

Decisions about the short-term (<5 years) use of HRT for the treatment of climacteric symptoms should be made separately from decisions about the long term use of HRT for the prevention of osteoporotic fractures.

 

HRT is the single most effective therapy for the management of troublesome hot flushes and other menopausal symptoms.

  

HRT prevents postmenopausal bone loss and is an effective therapy for established osteoporosis.   Bone mineral density measurement can be used to assess bone density before treatment is offered.  The optimum timing for osteoporosis prevention may be when a woman is in her 60s and 70s when fracture risk is rapidly increasing rather than in her 50s when fracture risk is relatively low.

 

Estrogen replacement therapy or oral estriol should not be given without a progestogen for women with a uterus.

 

There is insufficient evidence that HRT improves cognition or prevents or delays Alzheimer’s disease.

  

HRT is contraindicated for the secondary prevention of coronary artery disease.  There is insufficient evidence at present of benefit or harm from HRT for the primary prevention of coronary artery disease.

 

Short term HRT use (<5 years) does not increase the risk of breast cancer diagnosis.   Longer term HRT use (>5 years) may be associated with an increase in breast cancer diagnosis but it remains uncertain if mortality from breast cancer is affected.