A 51-year-old woman presents to your office with questions about whether postmenopausal hormone therapy (HT) is “dangerous.” She heard this on the news and read about it in a women’s magazine. She denies hot flushes, irregular menses, emotional lability, or vaginal dryness. She has hypertension, but is otherwise healthy. Her family history is negative for breast cancer and cardiovascular disease.
According to data from the Women’s Health Initiative study, what advice should you give her?
A. She should start HT for cardiovascular protectionData from the Women’s Health Initiative randomized trial of estrogen and progesterone in healthy postmenopausal women found a 26% increase in the risk of breast cancer over a mean follow-up of 5.2 years. This trial confirmed the benefit of HT in prevention of osteoporotic fractures, but did not show a benefit in prevention of coronary heart disease. Routine use of postmenopausal HT for prevention of coronary heart disease is no longer recommended. Vaginal estrogen cream is safe and effective treatment for postmenopausal vaginal atrophy. Short-term use of HT (< 5 years) for relief of menopausal symptoms in a healthy perimenopausal woman remains a reasonable and highly effective option. In this woman without perimenopausal symptoms, however, treatment would be premature.