Background

Hormone therapy (HT) has been used for over 50 years for treating menopausal vasomotor symptoms, and its efficacy is well established.

HT consists of oestrogen either alone or combined with a progestogen. Progestogen use reduces the risk of endometrial hyperplasia associated with unopposed oestrogen in women with a uterus. Clinical effects vary according to the type of HT and duration of use.

Until about 15 years ago, commonly held expert opinion (supported by strong observational evidence) was that most postmenopausal women could benefit from HT. It was widely used for the management or prevention of chronic conditions such as coronary heart disease (CHD) and osteoporotic fractures, and it was suggested that HT might also help to prevent cognitive decline and dementia. As CHD is the most common cause of death and morbidity in older women, a significant reduction in CHD risk would potentially outweigh any adverse effects of HT. Publication of evidence from the Heart and Estrogen/Progestin Replacement Study (HERS) and Women’s Health Initiative (WHI) trials in 2002 raised questions about the safety of HT.1 2

There are nine Cochrane systematic reviews about the effects of HT for perimenopausal and postmenopausal women. We felt it would be useful to include the most important long-term outcomes in a single Cochrane review, for the benefit of women contemplating its use for menopausal symptom relief. We decided to exclude studies shorter than 1 year and to exclude (as outcomes) menopausal symptom control, early-onset side effects and surrogate measures such as endometrial hyperplasia and bone mineral density. We recently published the third update of the review.3

Review methods

We aimed to assess the effects of long-term HT on mortality, cardiovascular outcomes, cancer, gallbladder disease, fracture and cognitive function in perimenopausal and postmenopausal women during and after cessation of treatment. We included double-blinded randomised controlled trials (RCTs) …