Prescribing hormone replacement therapy: key considerations for primary care physicians

I would expect a prescribing article about hormone replacement therapy (HRT) to be in line with the British Menopause Society, and evidence that oral oestrogen with its increased risk is no longer a first-line treatment, given that topical oestrogen is so much safer for all, not just the conditions cited in this article.¹

In addition, micronised progesterone is again so much safer. It thus renders what is now out-of-date HRT in combined oral or patches products, whether sequential or continuous combined, not really justifiable clinically unless the patient chooses a higher-risk treatment or is intolerant of progesterone.

Vaginal pessaries of 10 mcg are of some help, but many women need much higher doses of vaginal oestrogen and Estring^® is one option.

There is ongoing discussion about the overall health benefits for HRT, not just for symptom relief, but also for cardiovascular risk, improved metabolism, and bone protection.

I was surprised and disappointed that this article was published in the BJGP as it reads as being so out of date and unhelpful to the current issues about HRT. It does not address a major factor in prescribing, which is availability of drugs, and use of alternatives, which appears to be affecting HRT medication more than other drugs.