Published: June 2001

Updated HRT Guideline Released

Information on this subject has been updated. Read the most recent information.

Prescriber Update 21: 23-24
June 2001

In May 2001, the New Zealand Guidelines Group (NZGG) launched a new guideline called The Appropriate Prescribing of Hormone Replacement Therapy. It has an evidence-based approach and the key messages are presented below. The NZGG is distributing the Guideline to all prescribers over June/July 2001.

Medsafe would like to reinforce the warning in the Guideline that hormone replacement therapy (HRT) is contraindicated in existing coronary artery disease. This is a required statement in data sheets for HRT medicines. However, at present, some HRT products are indicated for reduction in risk of coronary heart disease (CHD) in women with no current or prior evidence of CHD. In light of the Guideline's advice that HRT is not recommended for the primary prevention of cardiovascular disease, Medsafe will be asking the Medicines Adverse Reactions Committee to comment on the appropriateness of this indication.

The Guideline has received endorsement by the NZGG and the following organisations: The Effective Practice Institute, The Royal NZ College of General Practice, Women's Health Action, NZ Heart Foundation, Australasian Menopause Society, The Cardiac Society of Australia and NZ, Family Planning Association, Osteoporosis NZ, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and the College of Nurses Aotearoa NZ.

Key messages of the new HRT Guideline

  • 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.
  • Two very large randomised controlled trials are currently underway which may clarify the benefits and risks of HRT over the next 5 to 10 years.

Contact NZGG for further information

Full details of the evidence found to support the new HRT Guideline is freely available on the NZGG website A detailed printed report is also available for purchase for $40 plus post and packaging from or ph 04 471 4180.