Randomised Trials on the long-term of hormone replacecment therapy:Criticism of women's health initiative study

Hippokratia 6(2):51 - 56

D Panidi, A Kourtis


Use of hormone replacement therapy (HRT) has increased among postmenopausal women in western countries: an estimated 20 million women worldwide were  using  HRT  in  the  late  1990s. Approximately 38% of postmenopausal women in the United States use  hormone  replacement  therapy.  In  2000,  46 million  prescriptions  were  written  for  Premarin (conjugated estrogens), making it the second most frequently prescribed medication in the United States and accounting for more than $1 billion in sales, and 22.3 million prescriptions were written for Prempro (conjugated  estrogens  plus  medroxyprogesterone acetate). Prempro is currently !DA-approved for: 1) treatment  of  moderate-to-severe  vasomotor  symptoms associated with the menopause, 2) treatment of vulvar and vaginal atrophy, and 3) prevention of post-menopausal osteoporosis. Early evidence from studies of unopposed estrogen suggested that it lowered risk of cardiovascular disease, consistent with resultsfrom  studies  of  intermediate  markers  that  showed beneficial changes. However, recent evidence from secondary prevention trials and observational studies  using  combined  estrogen/progestin  therapy showed  increased  risk  of  coronary  heart  disease (CHD)  in  the  first  year.  This  may  reflect prothrombotic  and  proinflammatory  effects  of progestins that outweigh any effects of estrogens on atherogenesis and vasodilatation. Hippokratia 2002, 6 (2): 51-56

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