The mythology of hormone replacement therapy

Abstract

Objective To evaluate the literature on contraindications contained in pharmaceutical data sheets of five currently available oestrogen replacement preparations (HRT). These contraindications include cardiovascular disease, diabetes, liver diseases, otosclerosis, endometriosis, melanoma and hormone‐dependent tumours. Design Systematic review. Interventions Oestrogen replacement regimens. Results The contraindications to the five HRT preparations have been taken uncritically from the data sheets of oral contraceptives. In some of these conditions not only is HRT not contraindicated, it is indicated. The data sheets for the HRT preparations all state that cardiovascular disease is a contraindication, but systematic review shows that ischaemic heart disease, hypertension and hyperlipidaemia are not contraindications, and in ischaemic heart disease HRT may actually be indicated. Similarly, systematic review shows that diabetes, chronic liver disease, endometriosis, some cases of treated cancer of the endometrium and breast, melanoma and otosclerosis are not contraindications to HRT. Conclusions The information in the pharmaceutical data sheets of HRT regimens should be modified as more accurate information could influence how these preparations are prescribed by doctors as well as affect patient compliance.

Prader–Willi Syndrome and Hypogonadism: A Review Article

“…Furthermore, hormone replacement therapy (HRT) with oestradiol is commonly used in PWS instead of alkyl oestradiol, the active ingredient in contraceptive pills that have a different safety profile. Oestradiol has a beneficial effect on cardiovascular function (e.g., hypertension), and epidemiological and basic science studies do not support the commonly held assumption that HRT increases the risk of thrombosis [49]. The psychological and psychosocial considerations are specific for PWS, and behavioural problems are part of the PWS phenotype.…”

Estrogen use and early onset Alzheimer's disease: a population-based study

“…In our study population, the administration of estrogens took place more than 10 years ago when vascular diseases were among the contraindications 13. To evaluate confounding by contraindication, we restricted the analyses to those without vascular pathology at the moment of the study.…”

Recurrent pain after hysterectomy and bilateral salpingo‐oophorectomy for endometriosis: evaluation of laparoscopic excision of residual endometriosis

“…Although there is some debate about when to commence hormone replacement therapy (HRT) following surgery 12 , there can be no doubt that HRT was required for its medical benefits in these women. As it is impossible to assess the level of risk of reactivation of endometriosis with HRT, removal of all such endometriosis should be performed at the time of hysterectomy 13 .…”