Table 1.
Benefits/risks of hormone therapy: 2004 Executive Summary (ACOG)
| Benefits | Comment | Relative risk: based on conjugated estrogen (CEE)/medroxyprogesterone (MPA) vs placebo of WHI |
|---|---|---|
| Vasomotor symptoms | Estrogens most effective treatment | N/A |
| Sexual dysfunction | Estrogens effective in relieving atrophy and dyspareunia | N/A |
| Skin | Increased collagen content and wrinkle reduction (non-sun-exposed areas | N/A |
| Genitourinary tract | Reduces atrophic vaginitis | N/A |
| Depression | Estrogen may have antidepressant effects | N/A |
| Colorectal cancer | 0.56 (0.38–0.81) | |
| Osteoporosis | Estrogens are effective antiresorptive agents and improves bone density | 0.76 (0.69–0.83)a |
| Risks | ||
| Breast cancer | 20 per 10,000 risk over 5 years if use combined estrogen/progestin therapy, no increased risk with estrogen therapy alone | 1.24 (1.01–1.54) |
| Coronary heart disease | Age: | |
| 50–59 | 1.27 (0.75–2.20) | |
| 60–69 | 1.05 (0.70–1.80) | |
| 70–79 | 1.44 (0.90–2.00) | |
| Years since menopause: | ||
| <10 | 0.89 (0.50–1.50) | |
| 10–19 | 1.22 (0.80–1.80) | |
| 20+ | 1.71 (1.20–2.50) | |
| Thromboembolic disease | 2-fold greater risk with increased risk of PE, highest risk during first year of use | DVT: 1.95 (1.43–2.67) PE: 2.13 (1.45–3.11) |
| Stroke | Randomized controlled trials show increased risk | 1.31 (1.02–1.68) |
| Cognition | Women’s Health Initiative Memory Study (WHIMS) – sbset of WHI, found increased risk of probable dementia | 2.05 (1.21–3.48) |
| Neutral | ||
| Weight changes/insulin resistance | No changes, glycemic control in type 2 diabetes unchanged by hormonal therapy | N/A |
| Osteoarthritis | N/A | |
| Ovarian and endometrial cancer | Ovarian: 1.58 (0.77–3.24) Endometrial: 0.81 (0.48–1.36) |
a
number of total fractures, including hip, vertebral and lower arm/wrist.
Abbreviations: PE, pulmonary embolism; DVT, deep vein thrombosis.