Published: 5 March 2020

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Hormone replacement therapy (HRT) reminder

Prescriber Update 41(1): 13
March 2020

Remember to prescribe hormone replacement therapy (HRT) at the lowest effective dose for the shortest duration possible. Review the need for continued use of HRT at least once every year.

A recent meta-analysis published in The Lancet confirmed an increased risk of breast cancer during treatment with all forms of HRT, except low-dose vaginal estrogen preparations1. This study found the risk of breast cancer increases with longer duration of HRT use. In addition, after stopping HRT, some excess risk persisted for more than 10 years.

HRT also increases the risk of venous thromboembolism and stroke2.

Carefully weigh the benefits and risks of treatment for each patient before initiating treatment and at regular intervals (at least yearly).

References

  1. Collaborative Group on Hormonal Factors in Breast Cancer. 2019. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet 394(10204): 1159–68. DOI: 10.1016/S0140-6736(19)31709-X (accessed 8 January 2020).
  2. Boardman HMP, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women (Review). Cochrane Database Syst Rev 2015, Issue 3, Art. No. CD002229. DOI: 10.1002/14651858.CD002229.pub4 (accessed 28 January 2020).
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