Hopefully, in the near future, drugs will be approved for the prevention of bone loss. A program of weight-bearing exercise and Vitamin D with calcium can be helpful. Doses were much higher 30 years ago, and unfortunately, much of the research has been done on those higher doses. Doses were higher in the past, and some complications like blood clots were more common. Studies have shown that blood clots have been a problem at higher doses, but this is less clear with the current dosage.
Doses continue to be lowered.
A few years ago the doses were almost double what we recommend now. Plus, the addition of Progesterone to the regimen of Estrogen alone has dramatically lowered the risk of uterine cancer. Also, now we have other options like Raloxifen, which is designed like a hormone, has many of the benefits, as protection from osteoporosis and heart disease without the potential risks to breast and uterus. Women with liver disease were unable to take HRT in the past. There are some questions of an increased incidence of breast cancer, but this is probably very low.