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Controversies in HRT.

BACKGROUND
Short term hormone replacement therapy (HRT) use is well established for menopausal symptom relief. However, the rates and duration of HRT use are increasing in Australia while the benefits and risks of long term HRT remain controversial.


OBJECTIVE
To review the evidence for the use of HRT for the prevention of cardiovascular disease (CVD) and osteoporosis as well as the increased risks of thrombosis and, potentially, breast cancer.


DISCUSSION
Cardiovascular disease and osteoporosis are common in western countries. Extensive epidemiological data suggests that HRT may protect against CVD and fracture, potentially offering significant long term health benefits to postmenopausal women. However, limited controlled trials focusing on CVD prevention have suggested no benefit from HRT. Also, there is limited controlled fracture end point data to support HRT use for the treatment of osteoporosis. Furthermore, potential benefits of long term HRT use need to be balanced against the risks of use, including increased thrombosis and potentially as suggested from epidemiological studies, increased breast cancer.