Hormone Replacement Therapy (HRT)

  • Nick NicholasEmail author


HRT has been the subject of intense debate since the publication of two major trials in Womens’ Health Initiative (WHI) and the Million Women Study (MWS) in the early 2000s, reporting an increased link with breast cancer that was greater in women taking combined HRT compared with estrogen only, and that the risk was time related. Furthermore, the WHI study demonstrated an increase in breast cancer, heart disease, stroke and VTE events whilst there was a reduction in fracture rate, bowel cancer and diabetes.

Reanalysis of the WHI study indicated that giving HRT to women within 10 years of the menopause conferred a cardioprotective effect with a reduction of cardiovascular events but later administration of HRT >20 years post menopause produced an increased risk of cardiovascular harm. This introduced the concept of the ‘window of opportunity’ with HRT use in the younger postmenopausal woman and that use of HRT >60 years of age was harmful.

There is still considerable confusion amongst GPs and hospital specialists as to what advice menopausal women should be given so that they can make an informed decision as to whether or not the risk/benefit ratio is acceptable to them.

Recent case law has heralded the advent of Informed consent in the UK putting considerable onus on healthcare professionals to counsel their patients about material risks associated with the prescription of HRT. Failure to do so could leave the prescriber open to litigation for medical negligence.


HRT Breast cancer Cardiovascular risk Informed consent Montgomery 


  1. 1.
    Townsend J, Nanchahal K. Br J Gen Pract. 2005;55:555.Google Scholar
  2. 2.
    Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2017;1:CD004143. Scholar
  3. 3.
    Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, et al. WHI Investigators. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women’s Health Initiative Randomized Trial. JAMA. 2003;289:3243–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Rossouw JE, Prentice RL, Manson JE, Wu L, Barad D, Barnabei VM, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007;297:1465–77.CrossRefPubMedGoogle Scholar
  5. 5.
    Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL, et al. Menopausal hormone therapy and health outcomes during the intervention and extended post stopping phases of the women’s health initiative randomized trials. JAMA. 2013;310(13):1353–68.CrossRefPubMedGoogle Scholar
  6. 6.
    Million Women Study Collaborators. Breast cancer and HRT in the Million Women Study. Lancet. 2003;362:419–27.CrossRefGoogle Scholar
  7. 7.
    Harman SM, Brinton EA, Cedars M, Lobo R, Manson JE, Merriam GR, Miller VM, Naftolin F, Santoro N. KEEPS: the Kronos early estrogen prevention study. Climacteric. 2005;8(1):3–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Schierbeck LL, Rejnmark L, Tofteng LC , Stilgren L, , Eiken P, Mosekilde L, Køber L and Jensen JBE Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012;345:e6409 doi: Scholar
  9. 9.
    NICE. Menopause Diagnosis and Management. NG 23; 2015.Google Scholar
  10. 10.
    Sismondi P, Kimmig R, Kubista E, Biglia N, Egberts J, Mulder R, et al. Effects of tibolone on climacteric symptoms and quality of life in breast cancer patients data from LIBERATE trial. Maturitas. 2011;70:365–72.CrossRefPubMedGoogle Scholar
  11. 11.
    Rippy L, Marsden J. Is HRT justified for symptom management in women at higher risk of developing breast cancer? Climacteric. 2006;9(6):404–15.CrossRefPubMedGoogle Scholar
  12. 12.
    Colditz GA, Kaphingst KA, Hankinson SE, Rosner B. Family history and risk of breast cancer: Nurses’ Health Study. Breast Cancer Res Treat. 2012;133:1097–104.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Domchek S, Kaunitz AM. Use of systemic hormone therapy in BRCA mutation carriers. Menopause. 2016;23(9):1026–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Montgomery v Lanarkshire Health Board. UKSC 11; 2015.Google Scholar
  15. 15.
    Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304:967–75.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Recommendations on Women’s mid life health and menopausal hormone therapy (MHT) in Climacteric. 2016:19:109–50.Google Scholar
  17. 17.
    Medicines and Health Regulatory Agency/Commission on Human Medicines. Drug Safety. 2007;1(2):2–6.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hillingdon Hospital NHS TrustUxbridgeUK

Personalised recommendations