In relatively healthy women , combined continuous HT significantly increased the risk of venous thrombo-embolism or coronary event ( after one year 's use ) , stroke ( after three years ) , breast cancer and gallbladder disease .
Long-term oestrogen-only HT significantly increased the risk of venous thrombo-embolism , stroke and gallbladder disease ( after one to two years , three years and seven years ' use respectively ) , but did not significantly increase the risk of breast cancer .
The only statistically significant benefits of HT were a decreased incidence of fractures and ( for combined HT ) colon cancer , with long-term use .
Among women aged over 65 who were relatively healthy ( i.e. generally fit , without overt disease ) and taking continuous combined HT , there was a statistically significant increase in the incidence of dementia .
Among women with cardiovascular disease , long-term use of combined continuous HT significantly increased the risk of venous thrombo-embolism .
AUTHORS ' CONCLUSIONS HT is not indicated for the routine management of chronic disease .
We need more evidence on the safety of HT for menopausal symptom control , though short-term use appears to be relatively safe for healthy younger women
BACKGROUND Hormone therapy ( HT ) is widely used for controlling menopausal symptoms and has also been used for the management and prevention of cardiovascular disease , osteoporosis and dementia in older women .
This is an up date d version of the original Cochrane review first published in 2005 .
OBJECTIVES To assess the effect of long-term HT on mortality , cardiovascular outcomes , cancer , gallbladder disease , cognition , fractures and quality of life .
Menopausal Symptoms and Treatment-Related Effects of Estrogen and Progestin in the Women's Health Initiative
OBJECTIVE : To estimate the effects of estrogen plus progestin ( E+P ) therapy on  menopausal symptoms , vaginal bleeding , gynecologic surgery rates , and treatment-related adverse effects  in postmenopausal women . METHODS : R and omized , double-blind , placebo-controlled trial of 16,608 postmenopausal women , ages 50–79 ( mean ± st and ard deviation 63.3 ± 7.1 ) years , with intact uterus , r and omized to one tablet per day containing 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate ( n = 8,506 ) or placebo ( n = 8,102 ) , and followed for a mean of 5.6 years . Change in symptoms and treatment-related effects were analyzed at year 1 in all participants . Bleeding and gynecologic surgery rates were analyzed through study close-out . RESULTS : Baseline symptoms did not differ between the treatment groups . More women assigned to E+P than placebo reported relief of hot flushes ( 85.7 % versus 57.7 % , respectively ; odds ratio 4.40 ; 95 % confidence interval 3.40–5.71 ) , night sweats ( 77.6 % versus 57.4 % ; 2.58 ; 2.04–3.26 ) , vaginal or genital dryness ( 74.1 % versus 54.6 % ; 2.40 ; 1.90–3.02 ) , joint pain or stiffness ( 47.1 % versus 38.4 % ; 1.43 ; 1.24–1.64 ) , and general aches or pains ( 49.3 % versus 43.7 % ; 1.25 ; 1.08–1.44 ) . Women asymptomatic at baseline who were assigned to E+P more often developed breast tenderness ( 9.3 % versus 2.4 % , respectively ; 4.26 ; 3.59–5.04 ) , vaginal or genital discharge ( 4.1 % versus 1.0 % ; 4.47 ; 3.44–5.81 ) , vaginal or genital irritation ( 4.2 % versus 2.8 % ; 1.52 ; 1.27–1.81 ) , and headaches ( 5.8 % versus 4.7 % ; 1.26 ; 1.08–1.46 ) than women on placebo . Estrogen plus progestin treatment prevented the onset of new musculoskeletal symptoms . Vaginal bleeding was reported by 51 % of women on E+P and 5 % of women on placebo at 6 months ; most bleeding was reported as spotting . Gynecologic surgeries ( hysterectomy and dilation and curettage ) were performed more frequently in women assigned to E+P ( 3.1 % versus 2.5 % for hysterectomy , hazard ratio = 1.23 , P = .026 ; 5.4 % versus 2.4 % for dilation and curettage , hazard ratio = 2.23 , P < .001 ) . CONCLUSION : Estrogen plus progestin relieved some menopausal symptoms , such as vasomotor symptoms and vaginal or genital dryness , but contributed to treatment-related effects , such as bleeding , breast tenderness , and an increased likelihood of gynecologic surgery . LEVEL OF EVIDENCE :
In relatively healthy women , combined continuous HT significantly increased the risk of venous thrombo-embolism or coronary event ( after one year 's use ) , stroke ( after three years ) , breast cancer and gallbladder disease .
Long-term oestrogen-only HT significantly increased the risk of venous thrombo-embolism , stroke and gallbladder disease ( after one to two years , three years and seven years ' use respectively ) , but did not significantly increase the risk of breast cancer .
The only statistically significant benefits of HT were a decreased incidence of fractures and ( for combined HT ) colon cancer , with long-term use .
Among women aged over 65 who were relatively healthy ( i.e. generally fit , without overt disease ) and taking continuous combined HT , there was a statistically significant increase in the incidence of dementia .
Among women with cardiovascular disease , long-term use of combined continuous HT significantly increased the risk of venous thrombo-embolism .
AUTHORS ' CONCLUSIONS HT is not indicated for the routine management of chronic disease .
We need more evidence on the safety of HT for menopausal symptom control , though short-term use appears to be relatively safe for healthy younger women
BACKGROUND Hormone therapy ( HT ) is widely used for controlling menopausal symptoms and has also been used for the management and prevention of cardiovascular disease , osteoporosis and dementia in older women .
This is an up date d version of the original Cochrane review first published in 2005 .
OBJECTIVES To assess the effect of long-term HT on mortality , cardiovascular outcomes , cancer , gallbladder disease , cognition , fractures and quality of life .