National Use of Postmenopausal Hormone Therapy

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Abstract
Patterns of hormone therapy use among postmenopausal women in the United States ideally should reflect known risks and benefits. However, definitive information on these risks and benefits was lacking until recently. The Heart and Estrogen/Progestin Replacement Study (HERS)1 and HERS follow-up (HERS II)2 concluded that postmenopausal hormone therapy with combination oral estrogen/progestin offered no cardiovascular disease benefit among women with established disease. The estrogen plus progestin trial of the Women's Health Initiative (WHI)3 demonstrated that hormone therapy with an estrogen/progestin combination caused increased risk of breast cancer and cardiovascular disease in postmenopausal women. These findings from randomized trials contrast with prior observational studies that suggested cardiovascular benefits.4-6 Based on the quality of recent data, new guidelines recommend against routine hormone therapy use for chronic conditions,7 and current users have been advised to taper doses toward discontinuation.8,9