Hormone replacement therapy (HRT) is prescribed to many women at the time of the menopause or following hysterectomy, both being circumstances in which circulating levels of the female hormone oestrogen, decline. HRT is treatment with oestrogen, or oestrogen and progestogen, to replace natural substances produced by a woman's body.

Oestrogen and progestogen control the menstrual cycle (periods) for about 30 years from puberty onwards. Many of the symptoms (hot flushes, sweats and other discomforts) which women experience at the time of the menopause are due to lack of oestrogen. The symptoms of natural menopause or one caused by treatment may be relieved by HRT and patients may also experience an increase in general wellbeing.

Recent publications have highlighted a number of safety concerns regarding long-term use of HRT. HRT experts have reassessed the risks and benefits of HRT and provided new recommendations about its use.1 They conclude:

For short-term treatment of menopausal symptoms the balance of risks and benefits is favourable - HRT

therefore remains a suitable treatment option. The minimum effective dose should be used for the shortest duration.

For long-term use for preventing osteoporosis, the balance of risks and benefits is unfavourable. HRT should only be used for preventing osteoporosis by those who are unable to take other osteoporosis prevention treatments or for whom other treatments have been unsuccessful.

In healthy women without symptoms, the balance of risks and benefits is generally unfavourable and HRT is not recommended.

It would be prudent to discuss this issue in depth with your doctor before making a decision on treatment options.

1. Review of the evidence regarding long-term safety of HRT. Current problems in Pharmacovigilance, October 2004. Medicines and Healthcare products regulatory agency (MHRA,UK).