Women taking HT had a significantly decreased incidence of fracture with long-term use .
Research ers found no strong evidence that HT has a clinical ly meaningful impact on the incidence of colorectal cancer .
AUTHORS ' CONCLUSIONS : Women with intolerable menopausal symptoms may wish to weigh the benefits of symptom relief against the small absolute risk of harm arising from short-term use of low-dose HT , provided they do not have specific contraindications .
HT may be unsuitable for some women , including those at increased risk of cardiovascular disease , increased risk of thromboembolic disease ( such as those with obesity or a history of venous thrombosis ) or increased risk of some types of cancer ( such as breast cancer , in women with a uterus ) .
The risk of endometrial cancer among women with a uterus taking oestrogen-only HT is well documented .
HT is not indicated for primary or secondary prevention of cardiovascular disease or dementia , nor for prevention of deterioration of cognitive function in postmenopausal women .
Although HT is considered effective for the prevention of postmenopausal osteoporosis , it is generally recommended as an option only for women at significant risk for whom non-oestrogen therapies are unsuitable .
BACKGROUND : Hormone therapy ( HT ) is widely provided for control of menopausal symptoms and has been used for the management and prevention of cardiovascular disease , osteoporosis and  dementia in older women .
This is an up date d version of a Cochrane review first published in 2005 .
OBJECTIVES : To assess effects of long-term HT ( at least 1 year 's duration ) on mortality , cardiovascular outcomes , cancer , gallbladder disease , fracture and cognition in perimenopausal and postmenopausal women during and after cessation of treatment .
Unopposed Estradiol Therapy in Postmenopausal Women: Results From Two Randomized Trials
OBJECTIVE : To estimate the rates of endometrial hyperplasia , bleeding episodes , and interventions among menopausal women receiving unopposed oral estradiol or placebo therapy with ultrasound monitoring over 3 years . METHODS : Two-hundred eighteen healthy women with intact uteri enrolled in the Estrogen in the Prevention of Atherosclerosis Trial ( EPAT ) or the Women ’s Estrogen-Progestin Lipid-Lowering Hormone Atherosclerosis Regression Trial ( WELL-HART ) were r and omly assigned to either 1 mg of micronized 17&bgr;-estradiol ( n=96 ) or placebo ( n=122 ) daily for up to 3 years in a double-blind fashion . Patients were followed with annual measurement of endometrial thickness using transvaginal ultrasonography . Logistic regression was used to identify predictors of uterine bleeding and endometrial biopsy . RESULTS : Over the study periods , nine women ( 9.4 % of patients , 95 % confidence interval [ CI ] 3.6–15.2 % ) in the estradiol group developed hyperplasia . Eight of the nine cases ( 88.9 % ) of hyperplasia were simple without atypia . Women receiving estradiol were more likely than those receiving placebo to have at least one episode of uterine bleeding ( 67 % versus 11 % at 3 years , respectively , P<.001 ) . Women in the estradiol group were also more likely to have an endometrial biopsy ( 48 % versus 4 % at 3 years , P<.001 ) . Among women on estradiol , obesity ( body mass index [ BMI ] greater than 30 kg/m2 ) significantly increased the odds of uterine bleeding compared with normal-weight patients ( BMI 25 or less ) ( OR 3.7 , 95 % CI 1.2–11.8 ) . CONCLUSION : Short-term , unopposed estradiol therapy with gynecologic monitoring may be an option for the treatment of menopausal symptoms . Menopausal women choosing estradiol therapy , especially if obese , should anticipate uterine bleeding and the possibility of an endometrial biopsy . CLINICAL TRIAL REGISTRATION : Clinical trials.gov , www . clinical trials.gov , NCT 00000559 and NCT 00115024 LEVEL OF EVIDENCE :
Women taking HT had a significantly decreased incidence of fracture with long-term use .
Research ers found no strong evidence that HT has a clinical ly meaningful impact on the incidence of colorectal cancer .
AUTHORS ' CONCLUSIONS : Women with intolerable menopausal symptoms may wish to weigh the benefits of symptom relief against the small absolute risk of harm arising from short-term use of low-dose HT , provided they do not have specific contraindications .
HT may be unsuitable for some women , including those at increased risk of cardiovascular disease , increased risk of thromboembolic disease ( such as those with obesity or a history of venous thrombosis ) or increased risk of some types of cancer ( such as breast cancer , in women with a uterus ) .
The risk of endometrial cancer among women with a uterus taking oestrogen-only HT is well documented .
HT is not indicated for primary or secondary prevention of cardiovascular disease or dementia , nor for prevention of deterioration of cognitive function in postmenopausal women .
Although HT is considered effective for the prevention of postmenopausal osteoporosis , it is generally recommended as an option only for women at significant risk for whom non-oestrogen therapies are unsuitable .
BACKGROUND : Hormone therapy ( HT ) is widely provided for control of menopausal symptoms and has been used for the management and prevention of cardiovascular disease , osteoporosis and  dementia in older women .
This is an up date d version of a Cochrane review first published in 2005 .
OBJECTIVES : To assess effects of long-term HT ( at least 1 year 's duration ) on mortality , cardiovascular outcomes , cancer , gallbladder disease , fracture and cognition in perimenopausal and postmenopausal women during and after cessation of treatment .