Hormone Replacement Therapy

HRT = estrogen + progesterone: The progesterone component is needed to protect the endometrium from constant stimulation and resultant increase in endometrial cancer. It is indicated for women who still have their uterus.

Risks of HRT/ERT

■ Increase incidence in breast cancer

■ Increase incidence in endometrial cancer (ERT only)

■ Thromboembolism

■ Cholecystitis/cholelithiasis

Risks can be reduced by beginning therapy years after menopause and/or treatment for only a few years.

Contraindications to HRT/ERT

■ Unexplained vaginal bleeding

■ Breast carcinoma (relative, not absolute, contraindication)

■ Metastatic endometrial carcinoma

■ Liver disease

■ History of thromboembolic disease

■ History of MI (ERT/HRT has not shown to be effective in cardioprotection after an MI has occurred)

HRT possibly increases the risk of breast cancer, but it definitely decreases the risk of coronary artery disease. Consider the following in assessing the risks and benefits of HRT: Breast cancer is the most common female malignancy, accounts for about 50,000 deaths/yr. Coronary artery disease is the most common cause of mortality, accounts for about 500,000 deaths/yr.

Estrogen creates a hypercoagulable state due to increased production of hepatic coagulation factors.





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